2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice.

To formulate evidence-based recommendations and overarching principles on the use of imaging in the clinical management of crystal-induced arthropathies (CiAs). An international task force of 25 rheumatologists, radiologists, methodologists, healthcare professionals and patient research partners from 11 countries was formed according to the EULAR standard operating procedures. Fourteen key questions on the role of imaging in the most common forms of CiA were generated. The CiA assessed included gout, calcium pyrophosphate deposition disease and basic calcium phosphate deposition disease. Imaging modalities included conventional radiography, ultrasound, CT and MRI. Experts applied research evidence obtained from four systematic literature reviews using MEDLINE, EMBASE and CENTRAL. Task force members provided level of agreement (LoA) anonymously by using a Numerical Rating Scale from 0 to 10. Five overarching principles and 10 recommendations were developed encompassing the role of imaging in various aspects of patient management: making a diagnosis of CiA, monitoring inflammation and damage, predicting outcome, response to treatment, guided interventions and patient education. Overall, the LoA for the recommendations was high (8.46-9.92). These are the first recommendations that encompass the major forms of CiA and guide the use of common imaging modalities in this disease group in clinical practice.

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“© European Alliance of Associations for Rheumatology, EULAR 2024. Re-use permitted under CC BY-NC-ND. No commercial re-use. No derivatives. See rights and permissions. Published by BMJ on behalf of EULAR.”.

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Competing interests: AA has received institutional research grants from AstraZeneca and Oxford Immunotech, royalty from UpToDate and Springer, lecture fees from Cadilla Pharmaceuticals, consulting fees from NGM Bio Limbic and Inflazome, all unrelated to the present work. AI has received honoraria, speaker fees and grants from AbbVie, Alfa-sigma, BMS, Celgene, Celltrion, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi Genzyme and Sobi. FB has received consulting fees from Horizon and has a research agreement with Siemens Healthineers. FP has received grants and personal fees from Novartis, Eli Lilly and UCB, and personal fees from AbbVie, Amgen, BMS, Celgene, Janssen, Hexal, Medscape, MSD, Pfizer and Roche outside the presented work. FP-R has received consulting fees from Arthrosi, Horizon, LG Pharma and Protalix; speaker fees from Horizon and Menarini; research grants from Cruces Rheumatology Association; fees in relation to trial committee or DMSB and Selecta-Sobi; and is on the steering committee of LG Pharma. HBH has received honorary for teaching from AbbVie, UCB, Lilly and Novartis and for participating in advisory boards from AbbVie and Novartis. JR has received unrestricted research grant from Sobi and Novartis, and speaker honoraria and consulting fees from BMS, Novartis and Sobi. LMS has received funding from Esaote SPA, Samsung Medison, GE HealthCare, Pfizer, Abiogen, AbbVie, Janssen-Cilag, Novartis, MSD, Merck Serono, Fidia Farmaceutici, RAW and EchoLight. LT has received speaker fees from Janssen, Novartis, GE and Eli Lilly, and is on the advisory board for UCB and Janssen. MAD'A has received speaker or consultant fees from Novartis, BMS, Janssen, Amgen, Boehringer Ingelheim, AbbVie, AstraZeneca, Pfizer, UCB and Eli Lilly. ND has received consulting fees, speaker fees or grants from AstraZeneca, Novartis, Horizon, Selecta, Arthrosi, JW Pharmaceutical Corporation, PK Med, LG Chem, JPI, PTC Therapeutics, Protalix, Unlocked Labs and Hikma. TP has received honorary from Novartis and research grants from Horizon Pharmaceuticals. VN-C has received consulting fees from AbbVie, Galapagos, Lilly, Novartis, Lilly, Pfizer and UCB, and speaker fees from AbbVie, Fresenius, Lilly, Novartis, Pfizer and UCB.