Routine radiographs of hands and feet help in effective management of early RA

 X-Rays are a gold standard for bone imaging, and diagnosis for many bone related disorders. Rheumatoid arthritis is one such chronic inflammatory disorder that can affect more than just the joints of human body timely diagnosis is very important as it greatly affects the quality of life.

Several studies recommend that patients with newly presenting arthritis suspected of Rheumatoid Arthritis (RA) should undergo routine radiographs of hands and feet (X-HF) as the presence of RA-associated erosions might be of diagnostic and prognostic value.

Evy Ulijn and team’s main objective was to investigate the prevalence, diagnostic and prognostic value of RA-associated erosions seen on routine X-HF in a large, recent cohort of newly presenting arthritis patients. The results published in American Journal of Rheumatology, suggests that routine X-HF in patients is a must in patients with newly presenting arthritis suspected of RA might be reconsidered, due to low prevalence of early erosive disease and lack of diagnostic and prognostic value.

Researchers conducted a retrospective cohort study was performed between 2016-2019 in patients with newly presenting arthritis suspected of RA. Patients were included if arthritis was present at diagnosis, Rheumatoid Factor and Anti-Citrullinated Protein Antibodies were measured, RA was noted in the differential diagnosis, and routine X-HF were conducted. Outcomes were the prevalence of ≥1 RA-associated erosion, and whether diagnostic or prognostic classification were changed by erosivity. Seronegative patients, patients without Acute Phase Reactants (APR) and patients with longer symptom duration were analyzed as subgroups.

The findings of the study are

• RA-associated erosions were found in 32/724 patients (4.4%, CI 3.1-6.2%). Erosions led to a change of diagnostic classification in two patients (0.3%, 95%CI 0.01-1.1%) and changed prognostic classification in three patients (0.4%, 95%CI 0.1-1.3%).

• Seronegative patients and patients without elevated APR had significantly lower prevalence of erosions (χ2 9.4, P=0.002, χ2 6.5, P=0.01).

• Longer symptom duration was not associated with a different prevalence of erosions (χ2 0.4, P=0.81).

Researchers concluded that “The recommendation of conducting routine X-HF in patients with newly presenting arthritis suspected of RA might be reconsidered, due to low prevalence of early erosive disease and lack of diagnostic and prognostic value.”

Reference: Evy Ulijn MD, Nathan den Broeder MSc, David Ten Cate PhD ; Limited Diagnostic and Prognostic Value of Routine Radiographs in Newly Presenting Arthritis Suspected of Rheumatoid Arthritis: A Retrospective Study, 07 November 2023, Am. J. of Rheu; DOI:https://doi.org/10.1002/acr.25271