Rheumatoid arthritis in adults: management

Recommendation ID: NG100/3
Question: Ultrasound in monitoring:- What is the clinical and cost effectiveness of using ultrasound to monitor disease in adults with RA when clinical examination is inconclusive or inconsistent with other signs of disease activity?
Any explanatory notes (if applicable): Why this is important:- RA is a chronic inflammatory condition that needs regular review to enable adjustments in management to achieve a target of remission or low disease activity.
Although ultrasound is able to show subclinical inflammation or erosions in some people in clinical remission, evidence from RCTs does not support using ultrasound for routine monitoring. However, ultrasound may be useful for assessing disease activity in some people with RA; specifically, when clinical examination is inconclusive or is inconsistent with other signs of disease activity (for example, pain or markers of inflammation). There is no reliable evidence on the added value of ultrasound as part of a monitoring strategy in these subgroups.
In addition, when there is inconsistency between clinical examination and disease activity, it may be unclear if the person has subclinical inflammatory synovitis or more of a widespread pain syndrome, which is not inflammatory. These need very different treatments, so it is important to define them accurately.

Source guidance details

Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	31/07/2018