Frequency of Radiologic Procedures in Patients With RA
Frequency of Radiologic Procedures in Patients With RA
Background Patients with rheumatoid arthritis (RA) undergo radiologic investigations for disease and comorbidity evaluation. The actual use of radiologic imaging in RA is unknown.
Methods Using the Rochester Epidemiology Project medical record linkage system, adult patients from previously assembled population-based cohorts of Olmsted County, Minnesota, residents who fulfilled the 1987 American College of Rheumatology criteria for RA in 1988 to 2007 and comparator subjects without RA of similar age and gender were studied. Data on all radiologic procedures performed were collected.
Results The study included 650 patients with RA and 650 patients without RA. Patients with RA had significantly more radiographs of the chest (rate ratio [RR], 1.33; 95% confidence interval [CI], 1.28–31.38), upper extremity (RR, 2.97; 95% CI, 2.80–83.17), lower extremity (RR, 2.05; 95% CI, 1.94–102.16), spine (RR, 1.46; 95% CI, 1.35–41.59), and hip, pelvis, or sacroiliac joints (RR, 1.14; 95% CI, 1.03–11.26), as well as bone radionuclide (RR, 1.90; 95% CI, 1.50–52.44) and dual-energy x-ray absorptiometry imaging (RR, 1.77; 95% CI, 1.59–61.98) compared with patients without RA. Among patients with RA, having a positive rheumatoid factor was associated with an increased likelihood of undergoing radiologic procedures (RR, 1.05; 95% CI, 1.02–11.07). Women with RA underwent more imaging procedures than men (RR, 1.20; 95% CI, 1.16–21.23).
Conclusions Patients with RA undergo more radiologic procedures than patients without RA. Among patients with RA, women and patients with a positive rheumatoid factor have more radiologic procedures. The utilization of radiography is likely a reflection of overall disease burden. Despite some guidelines, routine hand wrist radiographs were not obtained with regularity; "overuse" is unlikely.
Patients with rheumatoid arthritis (RA) have characteristic radiologic changes that have historically aided in the diagnosis of the disease as well as in assessment of disease progression. Although radiologic findings have only a limited role in the initial diagnosis of RA because typical findings occur in already advanced disease, radiographs and other imaging studies continue to be an important part of the initial evaluation and follow-up of patients with RA.
Radiologic imaging is used in disease diagnosis and clinical follow-up to follow treatment effects longitudinally. Conventional radiography has been used for this purpose, and it has been suggested that hand/wrist radiographs be obtained every 2 years for patients with RA. However, it is unclear how often radiographs are actually obtained in the longitudinal management of patients with RA.
In addition to the aforementioned tests to assess for disease burden, patients with RA undergo imaging as part of routine evaluation for comorbidities as well as in the setting of preventive services (eg, mammograms, dual-energy x-ray absorptiometry [DXA] scan for osteoporosis). There may be increased utilization of health care system resources, including some diagnostic imaging studies, in patients with RA.
In this study, we evaluated the use of radiologic procedures in patients with RA. We sought for the first time to determine whether the frequency of radiologic procedures is different in patients with RA compared with patients without RA.
Abstract and Introduction
Abstract
Background Patients with rheumatoid arthritis (RA) undergo radiologic investigations for disease and comorbidity evaluation. The actual use of radiologic imaging in RA is unknown.
Methods Using the Rochester Epidemiology Project medical record linkage system, adult patients from previously assembled population-based cohorts of Olmsted County, Minnesota, residents who fulfilled the 1987 American College of Rheumatology criteria for RA in 1988 to 2007 and comparator subjects without RA of similar age and gender were studied. Data on all radiologic procedures performed were collected.
Results The study included 650 patients with RA and 650 patients without RA. Patients with RA had significantly more radiographs of the chest (rate ratio [RR], 1.33; 95% confidence interval [CI], 1.28–31.38), upper extremity (RR, 2.97; 95% CI, 2.80–83.17), lower extremity (RR, 2.05; 95% CI, 1.94–102.16), spine (RR, 1.46; 95% CI, 1.35–41.59), and hip, pelvis, or sacroiliac joints (RR, 1.14; 95% CI, 1.03–11.26), as well as bone radionuclide (RR, 1.90; 95% CI, 1.50–52.44) and dual-energy x-ray absorptiometry imaging (RR, 1.77; 95% CI, 1.59–61.98) compared with patients without RA. Among patients with RA, having a positive rheumatoid factor was associated with an increased likelihood of undergoing radiologic procedures (RR, 1.05; 95% CI, 1.02–11.07). Women with RA underwent more imaging procedures than men (RR, 1.20; 95% CI, 1.16–21.23).
Conclusions Patients with RA undergo more radiologic procedures than patients without RA. Among patients with RA, women and patients with a positive rheumatoid factor have more radiologic procedures. The utilization of radiography is likely a reflection of overall disease burden. Despite some guidelines, routine hand wrist radiographs were not obtained with regularity; "overuse" is unlikely.
Introduction
Patients with rheumatoid arthritis (RA) have characteristic radiologic changes that have historically aided in the diagnosis of the disease as well as in assessment of disease progression. Although radiologic findings have only a limited role in the initial diagnosis of RA because typical findings occur in already advanced disease, radiographs and other imaging studies continue to be an important part of the initial evaluation and follow-up of patients with RA.
Radiologic imaging is used in disease diagnosis and clinical follow-up to follow treatment effects longitudinally. Conventional radiography has been used for this purpose, and it has been suggested that hand/wrist radiographs be obtained every 2 years for patients with RA. However, it is unclear how often radiographs are actually obtained in the longitudinal management of patients with RA.
In addition to the aforementioned tests to assess for disease burden, patients with RA undergo imaging as part of routine evaluation for comorbidities as well as in the setting of preventive services (eg, mammograms, dual-energy x-ray absorptiometry [DXA] scan for osteoporosis). There may be increased utilization of health care system resources, including some diagnostic imaging studies, in patients with RA.
In this study, we evaluated the use of radiologic procedures in patients with RA. We sought for the first time to determine whether the frequency of radiologic procedures is different in patients with RA compared with patients without RA.
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