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Frequency of Radiologic Procedures in Patients With Rheumatoid Arthritis

Venegas-Pont, Marcia MD*; Davis, John M. III MD, MS; Crowson, Cynthia S. MS; Gabriel, Sherine E. MD, MSc†§; Matteson, Eric L. MD, MPH†§

JCR: Journal of Clinical Rheumatology: January 2015 - Volume 21 - Issue 1 - p 15–18
doi: 10.1097/RHU.0000000000000164
Original Articles

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.

From the *Department of Medicine; †Division of Rheumatology; ‡Division of Biostatistics, Department of Health Sciences Research; and §Division of Epidemiology, Department of Health Sciences Research.

This work was funded by a grant from the National Institutes of Health, NIAMS (R01 AR46849). Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award R01AG034676.

The authors declare no conflict of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Correspondence: Eric L. Matteson, MD, MPH, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905. E-mail:

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