Page 43 - Imaging of Osteoarthritis and Rheumatoid Arthritis in Hand Joints
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 Systematic review of advanced hand OA imaging
improve over time and with new insights into OA. These improvements may lead to shorter scoring times, further improvement of reliability, validity and responsiveness, and hopefully a widely accepted consensus method.
A number of issues should be taken into account when interpreting the 2 results of this review. Our search was extensive but we might still have missed publications. Three articles were excluded because of language difficulties,22-24
as we could not reliably determine methodological quality and extract data.
We found no criterion validity studies in which histology or arthroscopy was used as a reference standard, probably because these are not easily obtained for hand OA. Not all included validity studies were primarily designed to assess validity, which might have limited their methodological quality. Comparison of construct validity studies was hindered by differences in pathology definition, statistical analysis, and comparators. Homogeneity of study design and reporting should therefore be improved in future studies.
We included data on DIP, PIP, MCP, CMC1 and STT joints, but did not asses differences between these joints. However, anatomical differences may affect imaging performance. For example, limited resolution of MRI may hamper assessment of the smaller DIP joints,34 while US may not fully assess the third and fourth MCP joints, due to a restricted acoustic window.75 Both MRI and US have technologically advanced in recent years, and results from older studies might therefore not be comparable with those of the newer studies. This may also explain why the only study in which US was less sensitive than CR, was also the oldest study that compared the two methods.38
In conclusion, MRI and US seem to be the most promising candidates for early detection of hand OA and for future use in clinical trials. However, further research is needed to improve scoring methods, compare US with MRI, confirm reliability of MRI, and better determine responsiveness of US and MRI.

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