Background/Purpose: Joint involvement (swelling, tenderness, deformity and incapacitating inflammatory arthritis) are present in 95% of SLE patients; 70-80% of lupus patients in clinical trials have active joint manifestations. Arthritis is a main cause of work-related disability. The objective of this study was to review the evidence on the application of musculoskeletal (MSK) ultrasound (US) and magnetic resonance imaging (MRI) in SLE patients with hand and wrist arthritis and to provide combined results data from these studies.

Methods: Separate PICOs structured literature searches without language restriction were conducted for US and MRI using PubMed, EMBASE and the Cochrane Library. The search for US was restricted to Jan 1, 2019 – Mar 31, 2024, as the previous systematic reviews included data until Dec 31, 2018. The searches for MRI were done without date restriction until March 31, 2024. The literature was reviewed according to PRISMA guidelines by 2 authors. The inclusion criteria were original research, >18 years old, classified SLE, >/=1patient, and inclusion of hands and wrists. The inter-reader agreement between the 2 authors for selection of the studies was 1.0. Following consensus, full text of the studies that met eligibility were acquired and assessed for the final determination of inclusion. The PRISMA flowchart was created. The quality assessment of studies was based on the QUADAS-2 instrument.

Results: Of 502 articles for US, 16 were included, of 2101 articles for MRI, 8 were included. Data on the use of MSK US and MRI were evaluated separately. For US, we assessed the definitions and scoring of the reported abnormalities, a summary of these data is shown in table 1. 9 US studies investigated the association between arthritis/arthralgia and US synovitis (Fig 1a.), the pooled odds ratio (OR) for the association was 7.11 (95% CI, 2.88 to 17.53). When the analysis was restricted to physician confirmed arthritis (Fig 1b.), the OR decreased to 5.28 (1.79, 15.55). 5 studies examined the association between arthritis/arthralgia and US tenosynovitis (Figure 1c); OR was 5.93 (95% CI 1.99, 17.72). For MRI, table 1 summarizes the main abnormalities, and table 2 provides further details. Unfortunately, we were unable to investigate the association between arthritis/arthralgia and the presence of MRI synovitis, tenosynovitis, or erosions because of the scoring heterogeneity of data reported.

Conclusion: The current systematic literature review examined available information on the use of advanced imaging modalities in the evaluation of SLE hand and wrist arthritis. These data support the use of US and MRI in SLE patients with symptomatic hand arthritis and arthralgia and to detect both symptomatic and asymptomatic MSK involvement as these have clinical and therapeutic implications. There is an urgent need for more precise evolutions of arthritis in clinical care and clinical trials as subjective joint evaluations impact routine care and the outcomes of clinical trials. Further investigation is needed to fully understand the clinical relevance of the newly defined clinical and imaging phenotypes, and their response to treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/advanced-imaging-in-the-evaluation-of-lupus-arthritis-a-systematic-literature-review-and-meta-analysis/