Abstract
ObjectiveTo determine how structural and inflammatory osteoarthritis (OA) features in peripheral joints are assessed, defined and graded by ultrasound (US) imaging. DesignMEDLINE, CINAHL, Cochrane and SPORTDiscus were systematically searched in March 2021. To be eligible, studies needed to (1) include participants with peripheral joint OA, and (2) used grey scale USI or power Doppler (PD) to assess one or more US features in peripheral joints of the hands and feet. Methodological quality of all included studies was assessed using the Critical Appraisal Skills Program (CASP) tool. ResultsA total of 159 citations were identified for screening. Thirty-two articles were included for final analysis and were of good methodological quality. Thirty articles evaluated US features of hand OA and two assessed US OA features in the foot. There were inconsistencies between studies in terms of what US features were assessed, how these features were defined and what grading system was applied to determine degree of osteoarthritic change. ConclusionThe review found inconsistencies in the definition of synovial pathology. Consequently, it is unclear whether synovial pathology is best represented as separate entities or combined as a single domain, termed “synovitis”. How OA US features were defined and graded has largely been extrapolated from recommendations originally constructed for populations with rheumatoid arthritis (RA). Given the prognostic value of synovitis for OA progression and the reduced degree of inflammation experienced in OA compared to RA, the validity of applying definitions, grading systems and atlases originally developed for inflammatory arthritis needs consideration.
Highlights
Osteoarthritis (OA) is a global health burden and leading cause of chronic pain, joint stiffness, functional limitation, and disability among older adults [1,2]
There were discrepancies across studies in terms of how synovitis, synovial hypertrophy and joint effusion were defined and categorised as US features. It is unclear whether synovial pathology is best represented as separate entities or combined as a single domain, termed “synovitis”
US presents an alternative to plain radiography for the imaging-based diagnosis of peripheral joint OA
Summary
Osteoarthritis (OA) is a global health burden and leading cause of chronic pain, joint stiffness, functional limitation, and disability among older adults [1,2]. Our knowledge of foot and hand OA substantially lags behind that of other joint sites, such as the knee and hip [7,8,9,10], for which the research evidence is more advanced. Plain radiography represents the gold standard imaging modality for the visualisation of bony change and the diagnosis of radiographic OA [14,15]. Radiographic imaging can detect joint space narrowing and bony alterations [16], it has numerous shortcomings in diagnosing OA. At the point where structural damage is evident radiographically, joint structure and function may be significantly impaired. Radiographic imaging cannot directly visualise articular cartilage or (http://creativecommons.org/licenses/by/4.0/)
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