Diagnostic issues in difficult-to-treat rheumatoid arthritis: A systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis
Roodenrijs, Nadia M.T.; Kedves, Melinda; Hamar, Attila; Nagy, György; Van Laar, Jacob M.; Van Der Heijde, Désireé; Welsing, Paco M.J.
(2021) RMD Open, volume 7, issue 1
(Article)
Abstract
Objectives To summarise the evidence on diagnostic issues in difficult-to-treat rheumatoid arthritis (D2T RA) informing the EULAR recommendations for the management of D2T RA. Methods A systematic literature review (SLR) was performed regarding the optimal confirmation of a diagnosis of rheumatoid arthritis (RA) and of mimicking diseases and the assessment
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of inflammatory disease activity. PubMed and Embase databases were searched up to December 2019. Relevant papers were selected and appraised. Results Eighty-two papers were selected for detailed assessment. The identified evidence had several limitations: (1) no studies were found including D2T RA patients specifically, and only the minority of studies included RA patients in whom there was explicit doubt about the diagnosis of RA or presence of inflammatory activity; (2) mostly only correlations were reported, not directly useful to evaluate the accuracy of detecting inflammatory activity in clinical practice; (3) heterogeneous, and often suboptimal, reference standards were used and (4) (thus) only very few studies had a low risk of bias. To ascertain a diagnosis of RA or relevant mimicking disease, no diagnostic test with sufficient validity and accuracy was identified. To ascertain inflammatory activity in patients with RA in general and in those with obesity and fibromyalgia, ultrasonography (US) was studied most extensively and was found to be the most promising diagnostic test. Conclusions This SLR highlights the scarcity of high-quality studies regarding diagnostic issues in D2T RA. No diagnostic tests with sufficient validity and accuracy were found to confirm nor exclude the diagnosis of RA nor its mimicking diseases in D2T RA patients. Despite the lack of high-quality direct evidence, US may have an additional value to assess the presence of inflammatory activity in D2T RA patients, including those with concomitant obesity or fibromyalgia.
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Keywords: arthritis, rheumatoid, synovitis, ultrasonography, Humans, Ultrasonography, Fibromyalgia, Arthritis, Rheumatoid/diagnosis, Immunology and Allergy, Rheumatology, Immunology, Research Support, Non-U.S. Gov't, Journal Article
ISSN: 2056-5933
Publisher: BMJ Publishing Group
Note: Funding Information: Competing interests NMTR, MK, AH and PMJW declare to have no competing interests. GN received fees from Amgen, AbbVie, BMS, Boehringer Ingelheim, Janssen, KRKA, Merck, MSD, Novartis, Pfizer, Roche, UCB; research grants from Pfizer, AbbVie. JMvL reports personal fees from Arxx Tx, Gesyntha, Magenta, Sanofi Genzyme, Leadiant, Boehringer-Ingelheim, Galapagos; grants and personal fees from Roche; grants from Astra Zeneca, MSD, Thermofisher. DvdH received consulting fees from AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB. All competing interests are outside the submitted work. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available from the corresponding author on reasonable request. Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. Funding Information: This project was funded by the European League Against Rheumatism. Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.
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