Recommendation for NHSScotland

There is evidence from a systematic review of a small number of studies to support the addition of Musculoskeletal Ultrasound to clinical assessment and laboratory testing to diagnose rheumatoid arthritis at an earlier stage of the disease. Use of ultrasound increased detection of joint inflammation and was more likely to correctly predict progression to inflammatory arthritis in patients with suspected rheumatoid arthritis.

No evidence was identified on the cost-effectiveness of MSUS in people with suspected rheumatoid arthritis.

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

What were we asked to look at?

In patients with suspected rheumatoid arthritis, does the addition of musculoskeletal ultrasound increase the ability of rheumatologists to confirm or rule out a diagnosis of rheumatoid arthritis at an earlier stage compared to conventional diagnostic assessment alone?

Why is this important?

With an increasing older population in Scotland the prevalence of rheumatoid arthritis is expected to increase. Early initiation of treatment with disease modifying anti-rheumatic drugs (DMARDs) - in the first weeks or months after symptoms develop - can prevent joint damage, improve longterm physical function and increase the likelihood of achieving clinical remission. Conventionally, diagnostic assessment for people with suspected rheumatoid arthritis has involved a clinical examination, laboratory tests and x-ray of the affected joints. Musculoskeletal ultrasound (MSUS) of the affected joints has been proposed as an additional aid to early diagnosis of people with suspected rheumatoid arthritis.

Referred by

The Scottish Society for Rheumatology.