Do not request a standard radiograph for diagnostic purposes in the clinical suspicion of an early-stage arthritis.

Type of practice




Topic Area


In this phase of the pathological process, this examination, especially in the “very early” forms (within 12 weeks from the onset), does not provide significant information, often dealing with conditions in the pre-radiographic stage and for which early changes are only evident through methods imaging with high sensitivity and adequate specificity. One of the most modern and complete methods to be used in the early phase, also at low cost, (within 12 months from the onset) seems to be the ultrasound examination with power doppler, then assigning in a second instance to the specialized evaluation the choice of the imaging method considered most appropriate for that individual case. After the rheumatologist has defined the diagnosis, the radiography can be performed to have an assessment at baseline for subsequent evaluations about the radiographic evolution.


1. Taylor PC, Steuer A, Gruber D et al. Comparison of ultrasonographic assessment of synovitis and joint vascularity with radiographic evaluation in a randomized, placebocontrolled study of infliximab therapy in earlyrheumatoid arth:ritis. Arthritis Rheum 2004; 50: 1107-16.
2. Iagnocco A, Filippucci E, Meenagh G, Delle Sedie A, Riente L, Bombardieri S, Grassi W, Valesini G. Ultrasound imaging for the rheumatologist. I. Ultrasonography of the shoulder. Clin Exp Rheumatol. 2006 Jan-Feb; 24(1): 6-11.
3. Iagnocco A, Porta F, Cuomo G, Delle Sedie A, Filippucci E, Grassi W, Sakellariou G, Epis O, Adinolfi A, Ceccarelli F, De Lucia O, Di Geso L, Di Sabatino V, Gabba A, Gattamelata A, Gutierrez M, Massaro L, Massarotti M, Perricone C, Picerno V, Ravagnani V, Riente L, Scioscia C, Naredo E, Filippou G; Musculoskeletal Ultrasound Study Group of the Italian Society of Rheumatology. The Italian MSUS Study Group recommendations for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatology. Rheumatology (Oxford). 2014 Feb; 53(2): 367-73.

Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.