EULAR Recommendations for the Use of Imaging in the Diagnosis and Management of Crystal-induced Arthropathies in Clinical Practice

Peter Mandl¹, Maria-Antonietta D'Agostino², Victoria Navarro-Compán³, Irina Gessl¹, Garifallia Sakellariou⁴, Abhishek Abhishek⁵, Fabio Becce⁶, Nicola Dalbeth⁷, Hang-Korng Ea⁸, Emilio Filippucci⁹, Hilde Berner Hammer¹⁰, Annamaria Iagnocco¹¹, Annette De Thurah¹², Esperanza Naredo¹³, Sebastien Ottaviani¹⁴, Tristan Pascart¹⁵, Fernando Perez-Ruiz¹⁶, Irene Pitsillidou¹⁷, Fabian Proft¹⁸, Juergen Rech¹⁹, Wolfgang Schmidt²⁰, Luca Sconfienza²¹, Lene Terslev²², Brigitte Wildner²³, Pascal Zufferey²⁴ and Georgios Filippou²⁵, ¹Department of Rheumatology, Medical University of Vienna, Vienna, Austria, ²Universita Cattolica del Sacro Cuore Rome, Courbevoie, France, ³Department of Rheumatology, La Paz University Hospital, IdiPaz, Madrid, Spain, ⁴Department of Internal Medicine and Therapeutics, Università di Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy, ⁵University of Nottingham, Nottingham, United Kingdom, ⁶Lausanne University Hospital (CHUV), Lausanne, Switzerland, ⁷University of Auckland, Auckland, New Zealand, ⁸Hôpital Lariboisière, APHP-Nord, Service de Rhumatologie, Université de Paris Cité, Paris, France, ⁹Polytechnic University of Marche, Jesi, Italy, ¹⁰Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway AND University of Oslo, Faculty of Medicine, Oslo, Norway, ¹¹University of Turin, Roma, Italy, ¹²Aarhus University Hospital, Aarhus, Denmark, ¹³Hospital Fundación, Madrid, Spain, ¹⁴Assistance Publique Hopitaux de Paris, Paris, France, ¹⁵Department of Rheumatology, Saint-Philibert Hospital, Lille Catholic University, Lille, France, ¹⁶Rheumatology Division, Osakidetza, OSI-EE Cruces, Cruces University Hospital, Barakaldo, Spain, ¹⁷EULAR Patient Research Partner, Executive Secretary of Cyprus League Against Rheumatism, Nicosia, Cyprus, ¹⁸Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, ¹⁹University Clinic Erlangen, Erlangen, Germany, ²⁰Rheumatology, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany, ²¹Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano AND IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy, ²²Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark, ²³University Library, Medical University of Vienna, Vienna, Austria, ²⁴Rheumatology Department, University of Lausanne, CHUV, Lausenne, Switzerland, ²⁵IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy

Meeting: ACR Convergence 2023

Keywords: CPPD, Crystal-induced arthritis, gout, Hydroxyapatite Deposition Disease/Calcific Periarthritis, Imaging

Session Information

Date: Monday, November 13, 2023

Title: (1100–1123) Metabolic & Crystal Arthropathies – Basic & Clinical Science Poster II

Session Type: Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: The multifaceted clinical presentation in crystal-induced arthropathies (CiA) poses challenges to imaging. Our goal was to formulate evidence-based recommendations on the use of imaging in the diagnosis and management of CiA.

Methods: An international task force of 25 rheumatologists, radiologists, methodologists, health care 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 (Table 1). The CiA assessed included gout, calcium pyrophosphate dihydrate deposition and basic calcium phosphate deposition. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging and computed tomography. Experts applied research evidence obtained from 4 systematic literature reviews using MEDLINE, EMBASE and CENTRAL after assessing for risk of bias. Task force members provided level of agreement (LoA) anonymously by using a numeric scale.

Results: Five overarching principles and 10 recommendations were produced on the role of imaging in making a diagnosis, monitoring inflammation, structural damage and crystal deposition, predicting severity and treatment effect, guiding intervention, and patient education in CiA (Table 2). Level of evidence and grade of recommendation was evaluated. Overall, the LoA for the recommendations was very high (8.5-9.9).

Conclusion: These are the first recommendations that encompass all common forms of CiA and guide the use of established imaging modalities in this disease group.

Table 1. Research questions. BCPD: basic calcium-phosphate deposition; CiA: crystal-induced arthropathy; CPPD: calcium-pyrophosphate deposition; RQ: research question

Table 2. EULAR Recommendations for the use of imaging in crystal-induced arthropathies in clinical practice. *1a for gout, 1a for CPPD, 5 for BCPD; $1a for US, 1a for CR, 1b for CT; #A for gout, A for CPPD, C for BCPD; §A for CR, A for US, B for CT
Numbers in column ‘LoA’ indicate the mean and SD (in parenthesis) of the LoA (range 0–10 with 0=‘completely disagree’ to 10=‘completely agree’),
BCPD: basic calcium phosphate deposition; CPPD: calcium pyrophosphate dihydrate deposition; DECT: dual-energy computed tomography; GoR: grades of recommendation; LoA: level of agreement; LoE: level of evidence; MTP1: first metatarsophalangeal; n.a., not applicable;

Disclosures: P. Mandl: AbbVie/Abbott, 5, 6, Bristol-Myers Squibb(BMS), 6, Celgene, 6, Eli Lilly, 6, Janssen, 6, Novartis, 5, 6, Pfizer, 5, Roche, 6, UCB, 5, 6; M. D'Agostino: None; V. Navarro-Compán: AbbVie, 2, 5, 6, Eli Lilly, 2, 6, Galapagos, 2, Janssen, 6, MoonLake, 2, MSD, 2, 6, Novartis, 2, 5, 6, Pfizer, 2, 6, UCB, 2, 6; I. Gessl: None; G. Sakellariou: None; A. Abhishek: Cadilla Pharmaceuticals, 12, lecture fees, Inflazome, 2, Limbic, 2, NGM Biopharmaceuticals, 2, Springer, 9, UpTodate, 9; F. Becce: Horizon Therapeutics, 2, Siemens Healthineers, 2; N. Dalbeth: Arthrosi, 2, AstraZeneca, 2, Dyve Biosciences, 2, Hikma, 6, Horizon, 2, JW Pharmaceutical Corporation, 2, LG, 2, Novartis, 6, Novotech, 5, PK Med, 2, Protalix, 2, PTC Therapeutics, 2, Selecta, 2, Unlocked Labs, 2; H. Ea: None; E. Filippucci: None; H. Hammer: None; A. Iagnocco: None; A. De Thurah: None; E. Naredo: AbbVie/Abbott, 6, Bristol-Myers Squibb(BMS), 6, Celgene, 6, Eli Lilly, 5, 6, Janssen, 6, Novartis, 6, Pfizer, 6, Roche, 6, UCB, 6; S. Ottaviani: None; T. Pascart: AbbVie/Abbott, 6, Bristol-Myers Squibb(BMS), 6, Pfizer, 6, Roche, 5, Sanofi, 6; F. Perez-Ruiz: None; I. Pitsillidou: None; F. Proft: AbbVie, 2, 6, Amgen, 2, 6, BMS, 2, 6, Celgene, 2, 6, Eli Lilly, 5, Hexal, 2, 6, Janssen, 2, 6, MSD, 2, 6, Novartis, 2, 5, 6, Pfizer, 2, 6, Roche, 2, 6, UCB Pharma, 2, 5, 6; J. Rech: AbbVie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD; Mylan, Novartis, Roche, Sanofi, Sobi, UCB, 2, 6, Novartis, Sobi, 5; W. Schmidt: AbbVie/Abbott, 1, 5, 6, Amgen, 1, 6, Bristol-Myers Squibb(BMS), 6, Chugai, 6, GlaxoSmithKlein(GSK), 1, 5, 6, Janssen, 6, Medac, 6, Novartis, 1, 5, 6, Roche, 6, UCB, 6; L. Sconfienza: Abiogen, 6, Bracco Imaging Italia, 6, Esaote, 6, Fidia, 6, Janssen, 6, Merck Serono, 6, Merck/MSD, 6, Novartis, 6, Pfizer, 6, Samsung, 6; L. Terslev: Eli Lilly, 1, Janssen, 1, 6, Novartis, 6, UCB, 1; B. Wildner: None; P. Zufferey: None; G. Filippou: None.

To cite this abstract in AMA style:

Mandl P, D'Agostino M, Navarro-Compán V, Gessl I, Sakellariou G, Abhishek A, Becce F, Dalbeth N, Ea H, Filippucci E, Hammer H, Iagnocco A, De Thurah A, Naredo E, Ottaviani S, Pascart T, Perez-Ruiz F, Pitsillidou I, Proft F, Rech J, Schmidt W, Sconfienza L, Terslev L, Wildner B, Zufferey P, Filippou G. EULAR Recommendations for the Use of Imaging in the Diagnosis and Management of Crystal-induced Arthropathies in Clinical Practice [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/eular-recommendations-for-the-use-of-imaging-in-the-diagnosis-and-management-of-crystal-induced-arthropathies-in-clinical-practice/. Accessed .

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