Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis

Background: Seronegative rheumatoid arthritis (SRA) is a condition that is not well understood and difficult to confirm by a conventional diagnostic process. We aimed to quantify the potential cost-savings of an alternative diagnostic process (ADP) imaging-based, for patients with presumptive SRA fr...

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Autores:: Santos-Moreno, Pedro
Alvis-Zakzuk, Nelson J
Castillo, Edwin
Villarreal, Laura
Pineda, Carlos
Sandoval, Hugo
Valencia, Omaira
Alvis Zakzuk, Nelson J.

Tipo de recurso:: Article of journal

Fecha de publicación:: 2021

Institución:: Corporación Universidad de la Costa

Repositorio:: REDICUC - Repositorio CUC

Idioma:: eng

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repository_id_str
dc.title.spa.fl_str_mv	Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis
title	Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis
spellingShingle	Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis cost-savings diagnosis imaging seronegative rheumatoid arthritis
title_short	Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis
title_full	Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis
title_fullStr	Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis
title_full_unstemmed	Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis
title_sort	Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis
dc.creator.fl_str_mv	Santos-Moreno, Pedro Alvis-Zakzuk, Nelson J Castillo, Edwin Villarreal, Laura Pineda, Carlos Sandoval, Hugo Valencia, Omaira Alvis Zakzuk, Nelson J.
dc.contributor.author.spa.fl_str_mv	Santos-Moreno, Pedro Alvis-Zakzuk, Nelson J Castillo, Edwin Villarreal, Laura Pineda, Carlos Sandoval, Hugo Valencia, Omaira
dc.contributor.author.none.fl_str_mv	Alvis Zakzuk, Nelson J.
dc.subject.spa.fl_str_mv	cost-savings diagnosis imaging seronegative rheumatoid arthritis
topic	cost-savings diagnosis imaging seronegative rheumatoid arthritis
description	Background: Seronegative rheumatoid arthritis (SRA) is a condition that is not well understood and difficult to confirm by a conventional diagnostic process. We aimed to quantify the potential cost-savings of an alternative diagnostic process (ADP) imaging-based, for patients with presumptive SRA from everyday clinical practice. Methods: We performed a retrospective analysis for patients with presumptive SRA who tested negative for both rheumatoid factor and anti-cyclic citrullinated peptide antibodies, through an ADP imaging-based, that is a standard clinical practice in our center. After we confirmed the diagnosis of SRA or reclassified patients in terms of another proper diagnosis, we estimate direct costs in two scenarios: a conventional and ADP. We compared the cost of RA treatment during the first year against the cost of the most misdiagnosed treatment (osteoarthritis) found after applying the ADP to determine potential cost-savings. Results: We included 440 patients with a presumptive diagnosis of SRA. According to the imaging-based ADP, SRA was confirmed in 106/440 (24.1%), unspecified RA in 9/440 (2.0%), and osteoarthritis in 325/440 (73.9%) of those patients. Although the costs of conventional diagnosis per patient is lower than those of ADP ($59,20 USD vs $269,57 USD), we found a potential drug cost-savings of $1,570,775.20 US Dollars after 1 year of correct treatment. Conclusion: An alternative diagnosis process, including X-rays, US and MRI imaging, and clinical and blood-test assessment, not only increased diagnostic certainty in patients referred for evaluation of presumptive SRA but also suggested a potential cost-savings in pharmacological treatments avoided in misdiagnosed patients.
publishDate	2021
dc.date.accessioned.none.fl_str_mv	2021-09-03T17:01:03Z
dc.date.available.none.fl_str_mv	2021-09-03T17:01:03Z
dc.date.issued.none.fl_str_mv	2021
dc.type.spa.fl_str_mv	Artículo de revista
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dc.identifier.uri.spa.fl_str_mv	https://hdl.handle.net/11323/8624
dc.identifier.doi.spa.fl_str_mv	https://doi.org/10.2147/CEOR.S302404
dc.identifier.instname.spa.fl_str_mv	Corporación Universidad de la Costa
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identifier_str_mv	Corporación Universidad de la Costa REDICUC - Repositorio CUC
dc.language.iso.none.fl_str_mv	eng
language	eng
dc.relation.references.spa.fl_str_mv	Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American college of rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–2581. doi:10.1002/art.27584 Nordberg LB, Lillegraven S, Aga AB, et al. Comparing the disease course of patients with seronegative and seropositive rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria in a treat-to-target setting: 2-year data from the ARCTIC trial. RMD Open. 2018;4(2):e000752. doi:10.1136/rmdopen-2018-000752 Ostergaard M, Pedersen SJ, Dohn UM. Imaging in rheumatoid arthritis- status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol. 2008;22(6):1019–1044. doi:10.1016/j.berh.2008.09.014 Pratt AG, Isaacs JD. Seronegative rheumatoid arthritis: pathogenetic and therapeutic aspects. Best Pract Res Clin Rheumatol. 2014;28(4):651–659. doi:10.1016/j.berh.2014.10.016 Vasanth LC, Pavlov H, Bykerk V. Imaging of rheumatoid arthritis. Rheum Dis Clin North Am. 2013;39(3):547–566. doi:10.1016/j.rdc.2013.03.007 Ostergaard M, Peterfy CG, Bird P, et al. The OMERACT rheumatoid arthritis magnetic resonance imaging (MRI) scoring system: updated recommendations by the OMERACT MRI in arthritis working group. J Rheumatol. 2017;44(11):1706–1712. doi:10.3899/jrheum.161433 Szkudlarek M, Terslev L, Wakefield RJ, et al. Summary findings of a systematic literature review of the ultrasound assessment of bone erosions in rheumatoid arthritis. J Rheumatol. 2016;43(1):12–21. doi:10.3899/jrheum.141416 Ostergaard M, Ejbjerg B, Szkudlarek M. Imaging in early rheumatoid arthritis: roles of magnetic resonance imaging, ultrasonography, conventional radiography and computed tomography. Best Pract Res Clin Rheumatol. 2005;19(1):91–116. doi:10.1016/j.berh.2004.08.006 Rudwaleit M, van der Heijde D, Landewe R, et al. The development of assessment of spondyloarthritis international society slassification criteria for axial spondyloarthritis (Part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777–783. doi:10.1136/ard.2009.108233 Aringer M, Costenbader K, Daikh D, et al. 2019 European league against rheumatism/American college of rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78(9):1151–1159. doi:10.1136/annrheumdis-2018-214819 Shiboski CH, Shiboski SC, Seror R, et al. 2016 American college of rheumatology/European league against rheumatism classification criteria for primary Sjogren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2017;76(1):9–16. doi:10.1136/annrheumdis-2016-210571 Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–2487. Terslev L, Naredo E, Aegerter P, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce- part 2: reliability and application to multiple joints of a standardised consensus-based scoring system. RMD Open. 2017;3(1):e000427. doi:10.1136/rmdopen-2016-000427 Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Ostergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003;48(4):955–962. doi:10.1002/art.10877 England BR, Tiong BK, Bergman MJ, et al. 2019 Update of the American college of rheumatology recommended rheumatoid arthritis disease activity measures. Arthritis Care Res. 2019;71(12):1540–1555. doi:10.1002/acr.24042 Smolen JS, Landewe R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960–977. doi:10.1136/annrheumdis-2016-210715 Hochberg MC, Altman RD, April KT, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–474. doi:10.1002/acr.21596 Rausch Osthoff AK, Niedermann K, Braun J, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77(9):1251–1260. doi:10.1136/annrheumdis-2018-213585 Instituto de Evaluación Tecnológica en Salud. Manual para la elaboración de evaluaciones económicas en salud. Bogotá, D.C: IETS; 2014. Husereau D, Drummond M, Petrou S, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Int J Technol Assess Health Care. 2013;29(2):117–122. doi:10.1017/s0266462313000160 Minsalud. SISMED - Sistema de Información de Precios de Medicamentos Ministerio Colombiano de Salud y Protección Social. 2019. Available from: https://www.sispro.gov.co/central-prestadores-de-servicios/Pages/SISMED-.... Accessed July8, 2019. Miles KA. Cancer imaging: is it cost-effective? Cancer Imaging. 2004;4(2):97–103. doi:10.1102/1470-7330.2004.0017 Rezaei H, Torp-Pedersen S, Af Klint E, et al. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis- a probabilistic approach. Arthritis Res Ther. 2014;16(5):448. doi:10.1186/s13075-014-0448-6 Jeka S, Dura M, Zuchowski P, Zwierko B, Waszczak-Jeka M. The role of ultrasonography in the diagnostic criteria for rheumatoid arthritis and monitoring its therapeutic efficacy. Adv Clinical Exp Med. 2018;27(9):1303–1307. doi:10.17219/acem/69133 Colebatch AN, Edwards CJ, Ostergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72(6):804–814. doi:10.1136/annrheumdis-2012-203158 Ventura-Ríos L, Hernández-Díaz C, Sánchez-Bringas G, Madrigal-Santillán E, Morales-González JA, Pineda C. A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound. Clin Rheumatol. 2016;35(9):2269–2276. doi:10.1007/s10067-016-3338-2 Sahatciu-Meka V, Rexhepi S, Manxhuka-Kerliu S, Rexhepi M. Radiographic estimation in seropositive and seronegative rheumatoid arthritis. Bosn J Basic Med Sci. 2011;11(3):180–184. doi:10.17305/bjbms.2011.2571 Chan KW, Felson DT, Yood RA, Walker AM. The lag time between onset of symptoms and diagnosis of rheumatoid arthritis. Arthritis Rheum. 1994;37(6):814–820. doi:10.1002/art.1780370606 Bird P, Conaghan P, Ejbjerg B, et al. The development of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis. 2005;64(Suppl 1):i8–i10. doi:10.1136/ard.2004.031807 Duer-Jensen A, Horslev-Petersen K, Hetland ML, et al. Bone edema on magnetic resonance imaging is an independent predictor of rheumatoid arthritis development in patients with early undifferentiated arthritis. Arthritis Rheum. 2011;63(8):2192–2202. doi:10.1002/art.30396 Sugimoto H, Takeda A, Hyodoh K. Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology. 2000;216(2):569–575. doi:10.1148/radiology.216.2.r00au20569 Nieuwenhuis WP, Krabben A, Stomp W, et al. Evaluation of magnetic resonance imaging-detected tenosynovitis in the hand and wrist in early arthritis. Arthritis Rheumatol. 2015;67(4):869–876. doi:10.1002/art.39000 Machado PM, Koevoets R, Bombardier C, van der Heijde DM. The value of magnetic resonance imaging and ultrasound in undifferentiated arthritis: a systematic review. J Rheumatol. 2011;87:31–37. doi:10.3899/jrheum.101072 Narváez J, Sirvent E, Narváez JA, et al. Usefulness of magnetic resonance imaging of the hand versus anticyclic citrullinated peptide antibody testing to confirm the diagnosis of clinically suspected early rheumatoid arthritis in the absence of rheumatoid factor and radiographic erosions. Semin Arthritis Rheum. 2008;38(2):101–109. doi:10.1016/j.semarthrit.2007.10.012 Buisman LR, Luime JJ, Oppe M, Hazes JMW, Rutten-van Molken MP. A five-year model to assess the early cost-effectiveness of new diagnostic tests in the early diagnosis of rheumatoid arthritis. Arthritis Res Ther. 2016;18(1):135. doi:10.1186/s13075-016-1020-3
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spelling	Santos-Moreno, PedroAlvis-Zakzuk, Nelson JCastillo, EdwinVillarreal, LauraPineda, CarlosSandoval, HugoValencia, OmairaAlvis Zakzuk, Nelson J.virtual::271-12021-09-03T17:01:03Z2021-09-03T17:01:03Z2021https://hdl.handle.net/11323/8624https://doi.org/10.2147/CEOR.S302404Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Background: Seronegative rheumatoid arthritis (SRA) is a condition that is not well understood and difficult to confirm by a conventional diagnostic process. We aimed to quantify the potential cost-savings of an alternative diagnostic process (ADP) imaging-based, for patients with presumptive SRA from everyday clinical practice. Methods: We performed a retrospective analysis for patients with presumptive SRA who tested negative for both rheumatoid factor and anti-cyclic citrullinated peptide antibodies, through an ADP imaging-based, that is a standard clinical practice in our center. After we confirmed the diagnosis of SRA or reclassified patients in terms of another proper diagnosis, we estimate direct costs in two scenarios: a conventional and ADP. We compared the cost of RA treatment during the first year against the cost of the most misdiagnosed treatment (osteoarthritis) found after applying the ADP to determine potential cost-savings. Results: We included 440 patients with a presumptive diagnosis of SRA. According to the imaging-based ADP, SRA was confirmed in 106/440 (24.1%), unspecified RA in 9/440 (2.0%), and osteoarthritis in 325/440 (73.9%) of those patients. Although the costs of conventional diagnosis per patient is lower than those of ADP ($59,20 USD vs $269,57 USD), we found a potential drug cost-savings of $1,570,775.20 US Dollars after 1 year of correct treatment. Conclusion: An alternative diagnosis process, including X-rays, US and MRI imaging, and clinical and blood-test assessment, not only increased diagnostic certainty in patients referred for evaluation of presumptive SRA but also suggested a potential cost-savings in pharmacological treatments avoided in misdiagnosed patients.Santos-Moreno, PedroAlvis-Zakzuk, Nelson JCastillo, EdwinVillarreal, LauraPineda, CarlosSandoval, HugoValencia, Omairaapplication/pdfengAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2ClinicoEconomics and Outcomes Researchhttps://pubmed.ncbi.nlm.nih.gov/34168469/cost-savingsdiagnosisimagingseronegative rheumatoid arthritisQuantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid ArthritisArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/acceptedVersionAletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American college of rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–2581. doi:10.1002/art.27584Nordberg LB, Lillegraven S, Aga AB, et al. Comparing the disease course of patients with seronegative and seropositive rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria in a treat-to-target setting: 2-year data from the ARCTIC trial. RMD Open. 2018;4(2):e000752. doi:10.1136/rmdopen-2018-000752Ostergaard M, Pedersen SJ, Dohn UM. Imaging in rheumatoid arthritis- status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol. 2008;22(6):1019–1044. doi:10.1016/j.berh.2008.09.014Pratt AG, Isaacs JD. Seronegative rheumatoid arthritis: pathogenetic and therapeutic aspects. Best Pract Res Clin Rheumatol. 2014;28(4):651–659. doi:10.1016/j.berh.2014.10.016Vasanth LC, Pavlov H, Bykerk V. Imaging of rheumatoid arthritis. Rheum Dis Clin North Am. 2013;39(3):547–566. doi:10.1016/j.rdc.2013.03.007Ostergaard M, Peterfy CG, Bird P, et al. The OMERACT rheumatoid arthritis magnetic resonance imaging (MRI) scoring system: updated recommendations by the OMERACT MRI in arthritis working group. J Rheumatol. 2017;44(11):1706–1712. doi:10.3899/jrheum.161433Szkudlarek M, Terslev L, Wakefield RJ, et al. Summary findings of a systematic literature review of the ultrasound assessment of bone erosions in rheumatoid arthritis. J Rheumatol. 2016;43(1):12–21. doi:10.3899/jrheum.141416Ostergaard M, Ejbjerg B, Szkudlarek M. Imaging in early rheumatoid arthritis: roles of magnetic resonance imaging, ultrasonography, conventional radiography and computed tomography. Best Pract Res Clin Rheumatol. 2005;19(1):91–116. doi:10.1016/j.berh.2004.08.006Rudwaleit M, van der Heijde D, Landewe R, et al. The development of assessment of spondyloarthritis international society slassification criteria for axial spondyloarthritis (Part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777–783. doi:10.1136/ard.2009.108233Aringer M, Costenbader K, Daikh D, et al. 2019 European league against rheumatism/American college of rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78(9):1151–1159. doi:10.1136/annrheumdis-2018-214819Shiboski CH, Shiboski SC, Seror R, et al. 2016 American college of rheumatology/European league against rheumatism classification criteria for primary Sjogren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2017;76(1):9–16. doi:10.1136/annrheumdis-2016-210571Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–2487.Terslev L, Naredo E, Aegerter P, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce- part 2: reliability and application to multiple joints of a standardised consensus-based scoring system. RMD Open. 2017;3(1):e000427. doi:10.1136/rmdopen-2016-000427Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Ostergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003;48(4):955–962. doi:10.1002/art.10877England BR, Tiong BK, Bergman MJ, et al. 2019 Update of the American college of rheumatology recommended rheumatoid arthritis disease activity measures. Arthritis Care Res. 2019;71(12):1540–1555. doi:10.1002/acr.24042Smolen JS, Landewe R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960–977. doi:10.1136/annrheumdis-2016-210715Hochberg MC, Altman RD, April KT, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–474. doi:10.1002/acr.21596Rausch Osthoff AK, Niedermann K, Braun J, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77(9):1251–1260. doi:10.1136/annrheumdis-2018-213585Instituto de Evaluación Tecnológica en Salud. Manual para la elaboración de evaluaciones económicas en salud. Bogotá, D.C: IETS; 2014.Husereau D, Drummond M, Petrou S, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Int J Technol Assess Health Care. 2013;29(2):117–122. doi:10.1017/s0266462313000160Minsalud. SISMED - Sistema de Información de Precios de Medicamentos Ministerio Colombiano de Salud y Protección Social. 2019. Available from: https://www.sispro.gov.co/central-prestadores-de-servicios/Pages/SISMED-.... Accessed July8, 2019.Miles KA. Cancer imaging: is it cost-effective? Cancer Imaging. 2004;4(2):97–103. doi:10.1102/1470-7330.2004.0017Rezaei H, Torp-Pedersen S, Af Klint E, et al. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis- a probabilistic approach. Arthritis Res Ther. 2014;16(5):448. doi:10.1186/s13075-014-0448-6Jeka S, Dura M, Zuchowski P, Zwierko B, Waszczak-Jeka M. The role of ultrasonography in the diagnostic criteria for rheumatoid arthritis and monitoring its therapeutic efficacy. Adv Clinical Exp Med. 2018;27(9):1303–1307. doi:10.17219/acem/69133Colebatch AN, Edwards CJ, Ostergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72(6):804–814. doi:10.1136/annrheumdis-2012-203158Ventura-Ríos L, Hernández-Díaz C, Sánchez-Bringas G, Madrigal-Santillán E, Morales-González JA, Pineda C. A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound. Clin Rheumatol. 2016;35(9):2269–2276. doi:10.1007/s10067-016-3338-2Sahatciu-Meka V, Rexhepi S, Manxhuka-Kerliu S, Rexhepi M. Radiographic estimation in seropositive and seronegative rheumatoid arthritis. Bosn J Basic Med Sci. 2011;11(3):180–184. doi:10.17305/bjbms.2011.2571Chan KW, Felson DT, Yood RA, Walker AM. The lag time between onset of symptoms and diagnosis of rheumatoid arthritis. Arthritis Rheum. 1994;37(6):814–820. doi:10.1002/art.1780370606Bird P, Conaghan P, Ejbjerg B, et al. The development of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis. 2005;64(Suppl 1):i8–i10. doi:10.1136/ard.2004.031807Duer-Jensen A, Horslev-Petersen K, Hetland ML, et al. Bone edema on magnetic resonance imaging is an independent predictor of rheumatoid arthritis development in patients with early undifferentiated arthritis. Arthritis Rheum. 2011;63(8):2192–2202. doi:10.1002/art.30396Sugimoto H, Takeda A, Hyodoh K. Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology. 2000;216(2):569–575. doi:10.1148/radiology.216.2.r00au20569Nieuwenhuis WP, Krabben A, Stomp W, et al. Evaluation of magnetic resonance imaging-detected tenosynovitis in the hand and wrist in early arthritis. Arthritis Rheumatol. 2015;67(4):869–876. doi:10.1002/art.39000Machado PM, Koevoets R, Bombardier C, van der Heijde DM. The value of magnetic resonance imaging and ultrasound in undifferentiated arthritis: a systematic review. J Rheumatol. 2011;87:31–37. doi:10.3899/jrheum.101072Narváez J, Sirvent E, Narváez JA, et al. 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Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis

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