The current level of evidence regarding the value of grayscale and Power Doppler abnormalities seen on musculoskeletal ultrasound to predict the development of inflammatory arthritis is sparse, according to a systematic literature review published in Arthritis Research & Therapy.

Researchers evaluated the scientific basis for the use of ultrasound to detect subclinical inflammation in patients experiencing joint symptoms that may indicate a progression to inflammatory arthritis. They identified longitudinal studies through to May 2017 using a systematic search of medical literature databases, with the quality of the studies being assessed by 2 independent reviewers who followed a set of 18 criteria. Scores ≥80.6% were considered high quality. Positive and negative likelihood ratios were determined, and the level of evidence was determined via best-evidence synthesis.

Six of 3061 unique references fulfilled the inclusion criteria of reporting on associations between grayscale and Power Doppler abnormalities and the development of inflammatory arthritis in arthralgia patients, 3 of which were high quality (2 of these reported on the same cohort). The comparability of results was hampered by heterogeneity in arthralgia populations and various scoring systems and ultrasound machines. The level of evidence was limited for use of grayscale abnormalities as a predictor, and the level of evidence was moderate for use of Power Doppler abnormalities as a predictor. Level of evidence for additive value of grayscale and Power Doppler abnormalities along with other biomarkers was limited to moderate. The estimated positive likelihood ratio values were mostly <4, whereas the negative likelihood ratio values were mostly >0.5.

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Study investigators conclude that although some studies have suggested a benefit to using ultrasound as a clinical predictor for patients in rheumatologic practices, “the current [level of evidence] is limited to moderate at best, due to heterogeneity of studies and lack of replication. Yet, there is a strong need for validation of results in future [ultrasound] studies, preferably performed in clearly defined, well-described arthralgia patients.”

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van den Berg R, Ohrndorf S, Kortekaas MC, van der Helm-van Mil AHM. What is the value of musculoskeletal ultrasound in patients presenting with arthralgia to predict inflammatory arthritis development? A systematic literature reviewArthritis Res Ther. 2018; 20(1):228.