Recommendation for NHSScotland

• A meta-analysis based on seven observational studies suggests that MSUS is clinically effective in predicting relapse or progression of joint damage in rheumatoid arthritis patients in clinical remission.
• Evidence from three additional primary studies suggests that MSUS can effectively identify rheumatoid arthritis patients in clinical remission who are suitable for tapering or stopping treatment, and can be used to monitor these patients for relapse.
• No evidence was identified on the cost effectiveness of MSUS in rheumatoid arthritis patients in clinical remission.

NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.

What were we asked to look at?

In patients with clinically stable rheumatoid arthritis (clinical remission), can musculoskeletal ultrasound in addition to clinical examination detect or rule out inflammation that predicts subsequent joint damage to inform tapering and stopping treatment?

Why is this important?

With an increasing older population in Scotland the prevalence of rheumatoid arthritis is expected to increase. Advances in treatments for rheumatoid arthritis have made clinical remission a realistic therapeutic goal, with up to 40% of patients achieving remission status within six months of initiating treatment. With remission rates increasing, and concerns over the safety and cost of long-term treatment, there is growing interest in tapering or stopping treatment in rheumatoid arthritis patients achieving clinical remission. Musculoskeletal ultrasound (MSUS) is a rapid, non-radioactive method of imaging which could potentially inform decisions on tapering or stopping treatment in rheumatoid arthritis patients in remission.

Referred by

The Scottish Society for Rheumatology.