fetching data ... 
Background The multifaceted clinical presentation in crystal-induced arthropathies (CiA) poses challenges to imaging.
Objectives To formulate evidence-based recommendations on the use of imaging in the diagnosis and management of CiA.
Methods Following EULAR standard operating procedures a task force of 25 stakeholders from 11 countries was created. Four systematic literature searches were performed in MEDLINE, EMBASE and CENTRAL to guide task force decisions, answering 14 research questions on the role of imaging in gout, calcium pyrophosphate and basic calcium phosphate deposition disease. Level of agreement (LoA) with each overarching principle and recommendation was assessed by numerical rating scale (0-10).
Results Five overarching principles and 10 recommendations were produced on the role of imaging in making a diagnosis, monitoring, predicting, guiding intervention, and patient education in CiA (Table 1). Overall, the LoA for the recommendations was very high (8.5-9.9).
Conclusion These are the first recommendations that encompass all common forms of CiA and guide the use of established imaging modalities in this disease group.
| Overarching principles | Level of agreement Mean (standard deviation) |
|---|---|
| A. CiA are typically characterized by intermittent, acute episodes of inflammation, but may also exhibit a persistent disease course with or without superimposed flares. | 9.8 (0.5) |
| B. Imaging in CiA provides useful information on crystal deposition, inflammation, and structural damage. | 9.8 (0.5) |
| C. The presence of imaging abnormalities, in particular those related to crystal deposition, may not always be related to clinical manifestations. | 9.8 (0.5) |
| D. Patient information (medical history, physical/laboratory examination, synovial fluid/tissue analysis) should be taken into account when imaging is considered in CiA. | 9.7 (0.7) |
| E. Imaging in CiA should be performed and interpreted by trained health care professionals. | 9.9 (0.4) |
| Recommendations | |
| 1. When performing imaging in CiA, both symptomatic areas and disease-specific target sites (i.e. MTP1 in gout, wrist and knee in CPPD, shoulder in BCPD) should be considered. | 9.7 (0.5) |
| 2. In the diagnostic assessment of gout, US and DECT are both recommended imaging modalities. | 9.7 (0.6) |
| 3. When characteristic features of MSU crystal deposition on US (i.e. double contour sign or tophi) or on DECT are identified, synovial fluid analysis is not needed to confirm a diagnosis of gout. | 8.8 (1.8) |
| 4. In the diagnostic assessment of CPPD, CR and US (or CT if axial involvement is suspected) are recommended imaging modalities. | 9.6 (0.9) |
| 5. In the diagnostic assessment of BCPD, imaging is necessary; CR or US are the recommended modalities. | 9.1 (1.7) |
| 6. In gout, US and DECT can be used to monitor crystal deposition and in case of US, also inflammation. Both modalities provide additional information on top of clinical and biochemical assessment. In case US/DECT are not available, CR can be used to assess structural damage due to gout. The decision on when to repeat imaging depends on the clinical circumstances. | 9.3 (1.2) |
| 7. In CPPD and BCPD serial imaging is not recommended, unless there is an unexpected change in clinical characteristics. | 9.4 (1.2) |
| 8. In gout, assessing the amount of MSU crystal deposition by US or DECT may be used to predict future flares. | 8.5 (1.7) |
| 9. If synovial fluid analysis is required in the assessment of CiA, US-guidance should be used in cases where aspiration based on anatomical landmarks is challenging. | 9.7 (0.5) |
| 10. Showing and explaining imaging findings of CiA to people with such conditions may help them understand their condition and improve treatment adherence in gout. | 9.4 (0.9) |
BCPD: basic calcium phosphate deposition disease; CiA: crystal-induced arthropathies; CPPD: calcium pyrophosphate deposition disease; CR: conventional radiography; CT: computed tomography; DECT: dual-energy computed tomography; MSU: monosodium urate; MTP: metatarsophalangeal joint; US: ultrasound
REFERENCES:
NIL.
Acknowledgements: NIL.
Disclosure of Interests Peter Mandl: None declared, Maria-Antonietta D’Agostino: None declared, Victoria Navarro-Compán: None declared, Irina Gessl: None declared, Garifallia Sakellariou: None declared, Abhishek Abhishek: None declared, Fabio Becce Consultant of: Horizon, Grant/research support from: Siemens Healthineers, Nicola Dalbeth: None declared, Hang Korng Ea: None declared, Emilio Filippucci: None declared, Hilde Berner Hammer: None declared, Annamaria Iagnocco: None declared, Annette de Thurah: None declared, Esperanza Naredo: None declared, Sebastien Ottaviani: None declared, Tristan Pascart Consultant of: Novartis, Grant/research support from: Horizon Pharmaceuticals, Fernando Perez-Ruiz: None declared, IRENE Pitsillidou: None declared, Fabian Proft: None declared, Jürgen Rech: None declared, Wolfgang A. Schmidt: None declared, Luca Maria Sconfienza Consultant of: Esaote SPA, Samsung Medison, Fidia Farmaceutici, Pfizer, Novartis, Janssen Cilag, Abiogen, Bracco Imaging Italia, MSD, Merck Serono, Grant/research support from: Esaote SPA, Samsung Medison, Fidia Farmaceutici, Pfizer, Novartis, Janssen Cilag, Abiogen, Bracco Imaging Italia, MSD, Merck Serono, Lene Terslev: None declared, Brigitte Wildner: None declared, Pascal Zufferey: None declared, Georgios Filippou: None declared.
Keywords: Imaging, Quality of care, Crystal Arthritis
DOI: 10.1136/annrheumdis-2023-eular.2414