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style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng100er9-lrg.png" alt="Cover of Ultrasound monitoring" /></a></div><div class="bkr_bib"><h1 id="_NBK577152_"><span itemprop="name">Ultrasound monitoring</span></h1><div class="subtitle">Rheumatoid arthritis in adults: diagnosis and management</div><p><b>Evidence review I</b></p><p><i>NICE Guideline, No. 100</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2018 Jul</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3003-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2018.</div></div><div class="bkr_clear"></div></div><div id="chi1"><h2 id="_chi1_">1. Ultrasound monitoring</h2><div id="chi1.s1"><h3>1.1. Review questions</h3><p>
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<b>In adults with rheumatoid arthritis (RA), what is the added value
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of monitoring disease activity with ultrasound?</b>
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</p><p>
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<b>In adults with poor prognosis rheumatoid arthritis, what is the
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added value of monitoring disease activity with
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ultrasound?</b>
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</p></div><div id="chi1.s2"><h3>1.2. Introduction</h3><p>Structural damage can happen quickly in rheumatoid arthritis if
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inflammation is not efficiently suppressed. The widespread use of
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strategies that aim for clinical remission or low disease activity has
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significantly improved the prognosis of rheumatoid arthritis. However,
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progressive bone erosion and relapses can still occur even in clinical
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remission.</p><p>Ultrasound can detect subclinical synovitis, but it is not known whether
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the use of ultrasound as part of routine monitoring results in improved
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patient outcomes.</p></div><div id="chi1.s3"><h3>1.3. PICO table</h3><p>For full details, see the review protocol in <a href="#pti.appa">Appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab1"><a href="/books/NBK577152/table/chi1.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab1" rid-ob="figobchi1tab1"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab1/?report=thumb" src-large="/books/NBK577152/table/chi1.tab1/?report=previmg" alt="Table 1. PICO characteristics of clinical effectivenss review." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab1"><a href="/books/NBK577152/table/chi1.tab1/?report=objectonly" target="object" rid-ob="figobchi1tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of clinical effectivenss review. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab2"><a href="/books/NBK577152/table/chi1.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab2" rid-ob="figobchi1tab2"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab2/?report=thumb" src-large="/books/NBK577152/table/chi1.tab2/?report=previmg" alt="Table 2. PICO characteristics of prognostic question." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab2"><a href="/books/NBK577152/table/chi1.tab2/?report=objectonly" target="object" rid-ob="figobchi1tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of prognostic question. </p></div></div><p>This review sought to investigate clinical assessment plus ultrasound
|
|
using 2 components. Firstly the review sought out randomised cotrolled
|
|
trials comparing monitoring with clinical assessment combined with
|
|
ultrasound versus monitoring via clinical assessment alone. The outcomes
|
|
would give a comparison of the clinical affectiveness of the monitoring
|
|
mthods.</p><p>The second component assessed the prognostic value of monitoring to
|
|
predict the outcomes of interest. The prognostic factors of interest
|
|
encompassed clinical assessment and ultrasound through measurement of
|
|
disease activity and ultrasound variables. Multivariate analysis was
|
|
utilised to assess whether single factors involved in the assessment
|
|
were independently associated with the outcomes of interest. Factors
|
|
such as tender joint count, swollen joint count, pain, C-reactive
|
|
protein (CRP), erythrocyte sedimentation rate (ESR) and anti-CCP are
|
|
measures utilised in disease assessment so they have been reported as
|
|
factors in the evidence.</p></div><div id="chi1.s4"><h3>1.4. Methods and process</h3><p>This evidence review was developed using the methods and process
|
|
described in Developing NICE guidelines: the manual.[ref to be added]
|
|
Methods specific to this review question are described in the review
|
|
protocol in <a href="#pti.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014
|
|
conflicts of interest policy.</p></div><div id="chi1.s5"><h3>1.5. Clinical evidence</h3><div id="chi1.s5.1"><h4>1.5.1. Included studies</h4><p>A search was conducted for randomised controlled trials and
|
|
systematic reviews of these study types in the first instance.
|
|
However as evidence was limited, prospective prognostic cohort
|
|
studies were also searched for.</p><p>One randomised controlled trial and 5 prognostic studies were
|
|
included in the review; they are summarised in <a href="/books/n/niceng100eri1/?report=reader" class="toc-item">Table 3</a> and <a href="/books/n/niceng100eri1/?report=reader" class="toc-item">Table 4</a> below. Evidence
|
|
from these studies is summarised in the clinical evidence summaries
|
|
below (see <a href="/books/n/niceng100eri1/?report=reader" class="toc-item">Table 6</a>,
|
|
<a href="/books/n/niceng100eri1/?report=reader" class="toc-item">Table 7</a>, <a href="/books/n/niceng100eri1/?report=reader" class="toc-item">Table 8</a>, <a href="/books/n/niceng100eri1/?report=reader" class="toc-item">Table 9</a>, <a href="/books/n/niceng100eri1/?report=reader" class="toc-item">Table 10</a> and <a href="/books/n/niceng100eri1/?report=reader" class="toc-item">Table 11</a>).</p><p>See also the study selection flow chart in <a href="#pti.appc">appendix C</a>, study evidence tables in <a href="#pti.appd">appendix D</a>, forest plots in
|
|
<a href="#pti.appe">appendix E</a> and GRADE
|
|
tables in <a href="#pti.apph">appendix H</a>.</p></div><div id="chi1.s5.2"><h4>1.5.2. Excluded studies</h4><p>See the excluded studies list in <a href="#pti.appi">appendix I</a>.</p></div><div id="chi1.s5.3"><h4>1.5.3. Summary of clinical studies included in the evidence
|
|
review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab3"><a href="/books/NBK577152/table/chi1.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab3" rid-ob="figobchi1tab3"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab3/?report=thumb" src-large="/books/NBK577152/table/chi1.tab3/?report=previmg" alt="Table 3. Summary of randomised controlled trials included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab3"><a href="/books/NBK577152/table/chi1.tab3/?report=objectonly" target="object" rid-ob="figobchi1tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Summary of randomised controlled trials included in the
|
|
evidence review. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab4"><a href="/books/NBK577152/table/chi1.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab4" rid-ob="figobchi1tab4"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab4/?report=thumb" src-large="/books/NBK577152/table/chi1.tab4/?report=previmg" alt="Table 4. Summary of prospective cohort prognostic studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab4"><a href="/books/NBK577152/table/chi1.tab4/?report=objectonly" target="object" rid-ob="figobchi1tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Summary of prospective cohort prognostic studies included
|
|
in the evidence review. </p></div></div><p>See <a href="#pti.appd">appendix D</a> for full
|
|
evidence tables.</p></div><div id="chi1.s5.4"><h4>1.5.4. Quality assessment of clinical studies included in the evidence
|
|
review</h4><div id="chi1.s5.4.1"><h5>1.5.4.1. RCTs</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab5"><a href="/books/NBK577152/table/chi1.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab5" rid-ob="figobchi1tab5"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab5/?report=thumb" src-large="/books/NBK577152/table/chi1.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: clinical assessment and ultrasound versus clinical assessment alone." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab5"><a href="/books/NBK577152/table/chi1.tab5/?report=objectonly" target="object" rid-ob="figobchi1tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: clinical assessment and
|
|
ultrasound versus clinical assessment alone. </p></div></div></div><div id="chi1.s5.4.2"><h5>1.5.4.2. Prognostic studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab6"><a href="/books/NBK577152/table/chi1.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab6" rid-ob="figobchi1tab6"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab6/?report=thumb" src-large="/books/NBK577152/table/chi1.tab6/?report=previmg" alt="Table 6. Clinical evidence summary - Outcome: MRI erosive progression (dichotomous – at 1 year)." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab6"><a href="/books/NBK577152/table/chi1.tab6/?report=objectonly" target="object" rid-ob="figobchi1tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary - Outcome: MRI erosive
|
|
progression (dichotomous – at 1 year). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab7"><a href="/books/NBK577152/table/chi1.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab7" rid-ob="figobchi1tab7"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab7/?report=thumb" src-large="/books/NBK577152/table/chi1.tab7/?report=previmg" alt="Table 7. Clinical evidence summary - Outcome: Disease flare (increase in disease activity requiring an initiation, change or increase in therapy based on DAS28; dichotomous – at 1 year)." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab7"><a href="/books/NBK577152/table/chi1.tab7/?report=objectonly" target="object" rid-ob="figobchi1tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary - Outcome: Disease flare
|
|
(increase in disease activity requiring an initiation,
|
|
change or increase in therapy based on DAS28;
|
|
dichotomous – at 1 year). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab8"><a href="/books/NBK577152/table/chi1.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab8" rid-ob="figobchi1tab8"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab8/?report=thumb" src-large="/books/NBK577152/table/chi1.tab8/?report=previmg" alt="Table 8. Clinical evidence summary - Outcome: Relapse (dichotomous – at 1 year; DAS28-ESR>2.6 following a period of clinical remission)." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab8"><a href="/books/NBK577152/table/chi1.tab8/?report=objectonly" target="object" rid-ob="figobchi1tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary - Outcome: Relapse
|
|
(dichotomous – at 1 year; DAS28-ESR>2.6
|
|
following a period of clinical remission). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab9"><a href="/books/NBK577152/table/chi1.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab9" rid-ob="figobchi1tab9"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab9/?report=thumb" src-large="/books/NBK577152/table/chi1.tab9/?report=previmg" alt="Table 9. Clinical evidence summary - Outcome: Remission (DAS28-CRP4v <2.6; dichotomous – at 1 year)." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab9"><a href="/books/NBK577152/table/chi1.tab9/?report=objectonly" target="object" rid-ob="figobchi1tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary - Outcome: Remission
|
|
(DAS28-CRP4v <2.6; dichotomous – at 1
|
|
year). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab10"><a href="/books/NBK577152/table/chi1.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab10" rid-ob="figobchi1tab10"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab10/?report=thumb" src-large="/books/NBK577152/table/chi1.tab10/?report=previmg" alt="Table 10. Clinical evidence summary - Outcome: Remission (DAS44-CRP4v <1.6; dichotomous – at 1 year)." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab10"><a href="/books/NBK577152/table/chi1.tab10/?report=objectonly" target="object" rid-ob="figobchi1tab10">Table 10</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary - Outcome: Remission
|
|
(DAS44-CRP4v <1.6; dichotomous – at 1
|
|
year). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab11"><a href="/books/NBK577152/table/chi1.tab11/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab11" rid-ob="figobchi1tab11"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab11/?report=thumb" src-large="/books/NBK577152/table/chi1.tab11/?report=previmg" alt="Table 11. Clinical evidence summary - Outcome: Function (HAQ score; continuous – 1 year after prognostic variables were measured)." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab11"><a href="/books/NBK577152/table/chi1.tab11/?report=objectonly" target="object" rid-ob="figobchi1tab11">Table 11</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary - Outcome: Function (HAQ
|
|
score; continuous – 1 year after prognostic
|
|
variables were measured). </p></div></div><p>See <a href="#pti.appf">appendix F</a> for
|
|
full GRADE tables.</p></div></div></div><div id="chi1.s6"><h3>1.6. Economic evidence</h3><div id="chi1.s6.1"><h4>1.6.1. Included studies</h4><p>No relevant health economic studies were identified.</p></div><div id="chi1.s6.2"><h4>1.6.2. Excluded studies</h4><p>No health economic studies that were relevant to this question were
|
|
excluded due to assessment of limited applicability or
|
|
methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#pti.appg">appendix G</a>.</p></div><div id="chi1.s6.3"><h4>1.6.3. Unit costs</h4><p>The unit costs of rheumatology appointments and of unbundled
|
|
diagnostic ultrasound imaging are provided below for guidance.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab12"><a href="/books/NBK577152/table/chi1.tab12/?report=objectonly" target="object" title="Table 12" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab12" rid-ob="figobchi1tab12"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab12/?report=thumb" src-large="/books/NBK577152/table/chi1.tab12/?report=previmg" alt="Table 12. Cost of outpatient rheumatology appointments." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab12"><a href="/books/NBK577152/table/chi1.tab12/?report=objectonly" target="object" rid-ob="figobchi1tab12">Table 12</a></h4><p class="float-caption no_bottom_margin">Cost of outpatient rheumatology appointments. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchi1tab13"><a href="/books/NBK577152/table/chi1.tab13/?report=objectonly" target="object" title="Table 13" class="img_link icnblk_img figpopup" rid-figpopup="figchi1tab13" rid-ob="figobchi1tab13"><img class="small-thumb" src="/books/NBK577152/table/chi1.tab13/?report=thumb" src-large="/books/NBK577152/table/chi1.tab13/?report=previmg" alt="Table 13. Cost of ultrasound." /></a><div class="icnblk_cntnt"><h4 id="chi1.tab13"><a href="/books/NBK577152/table/chi1.tab13/?report=objectonly" target="object" rid-ob="figobchi1tab13">Table 13</a></h4><p class="float-caption no_bottom_margin">Cost of ultrasound. </p></div></div></div></div><div id="chi1.s7"><h3>1.7. Resource costs</h3><p>The recommendations made in this review are not expected to have a
|
|
substantial impact on resources.</p></div><div id="chi1.s8"><h3>1.8. Evidence statements</h3><div id="chi1.s8.1"><h4>1.8.1. Clinical evidence statements</h4><p>Evidence from 1 RCT showed no clinically important difference between
|
|
monitoring with or without ultrasound in terms of disease activity,
|
|
quality of life, function, remission, pain or withdrawal due to
|
|
adverse events. Monitoring with ultrasound showed a small benefit in
|
|
terms of lower radiological progression and fewer withdrawals from
|
|
the trial due to willingness to participate; however, there was
|
|
considerable uncertainty in the direction of these effects, limiting
|
|
the ability to draw firm conclusions (1 to 2 years, moderate
|
|
quality, n=230).</p><p>Evidence from 5 prospective cohort studies with prognostic analysis
|
|
collectively reporting on 6 different outcomes at 1 year was highly
|
|
inconsistent. Ultrasound grey scale inflammation was reported by 1
|
|
study (n=84, high to very low quality) to be independently
|
|
associated with subsequent MRI erosive progression, but was not
|
|
found to be independently associated with remission (1 study, n=217,
|
|
very low quality) or function (1 study, n=93, low to very low
|
|
quality). Synovial hypertrophy was found to be independently
|
|
associated with a reduced risk of relapse. Power Doppler (PD)
|
|
measures were independently associated with disease flare in 1 study
|
|
(n=126, low to very low quality), in 2 studies (n=185 and 217, low
|
|
to very low quality). The association between PD and the relapse or
|
|
function was present for some PD measures but not others, two
|
|
studies found no independent association between PD and remission
|
|
(n=217, very low quality) or function (n=185) (low to very low
|
|
quality). No single ultrasound factor was found to consistently
|
|
predict the outcomes utilised by the studies included in the
|
|
review.</p></div><div id="chi1.s8.2"><h4>1.8.2. Health economic evidence statements</h4><ul id="l225"><li id="lt689" class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div><div id="chi1.s9"><h3>1.9. The committee’s discussion of the evidence</h3><div id="chi1.s9.1"><h4>1.9.1. Interpreting the evidence</h4><div id="chi1.s9.1.1"><h5>1.9.1.1. The outcomes that matter most</h5><p>Ultrasound is used to monitor disease activity in addition to
|
|
clinical assessment; therefore, the most critical outcome was
|
|
agreed to be the DAS. Other critical outcomes were agreed as
|
|
quality of life and function.</p><p>The important outcomes were agreed as the number of people in
|
|
remission, and low disease activity, using DAS thresholds. The
|
|
committee agreed that data reported in this format is not as
|
|
informative as continuous DAS data but still gives an indication
|
|
of symptom relief and disease activity improvement. Other
|
|
important outcomes were the number of people experiencing a
|
|
relapse, flare, a change in planned management at time of
|
|
testing, or withdrew from or adhered to trial, as well as the
|
|
level of pain and radiographic progression.</p><p>For most outcomes, 12-month data was sought apart from
|
|
radiographic progression where the longest reported time point
|
|
was reported. Outcomes of change in planned management at the
|
|
time of testing and withdrawal from trial data from the duration
|
|
of the entire trial was of interest.</p><p>No data were available for the outcomes of low disease activity
|
|
and change in planned management at the time of testing.</p></div><div id="chi1.s9.1.2"><h5>1.9.1.2. The quality of the evidence</h5><p>The review included a single randomised controlled trial (RCT).
|
|
The evidence was moderate quality for all of the critical
|
|
outcomes (change in DAS, change in Rheumatoid Arthritis Impact
|
|
of Disease Score (RAID), and change in quality of life (EQ-5D))
|
|
as well as the important outcomes of change in radiological
|
|
progression and change in pain. The evidence was generally at
|
|
high risk of bias due to the absence of blinding in the study
|
|
and the subjective nature of the outcomes reported; only
|
|
radiographic progression was at low risk of bias.</p><p>Further evidence was available from 5 prognostic studies, but
|
|
this was generally of low to very low quality and could not be
|
|
pooled as each study reported different outcomes. The majority
|
|
of evidence was considered to be at very serious risk of bias.
|
|
The committee discussed 1 study that reported that 52% of
|
|
participants were lost to follow up or excluded from the
|
|
analysis due to their outcome data being incomplete without
|
|
explanation for the missing data. Many of the other studies had
|
|
high levels of participants lost to follow up, or failed to
|
|
report missing data at all. This, combined with low quality,
|
|
reduced the committee’s certainty in the results despite
|
|
the studies meeting the inclusion criteria.</p><p>Another limitation was that many studies failed to report key
|
|
aspects of their statistical methods. For many of the outcomes,
|
|
there were small numbers of participants and low numbers of
|
|
events, resulting in wide confidence intervals, meaning there
|
|
was considerable uncertainty as to whether the factor was
|
|
associated with better or poorer outcomes. The impact of these
|
|
limitations of the evidence was that the committee agreed they
|
|
could not place much weight on the data from the prognostic
|
|
studies. No studies were found that looked at people with poor
|
|
prognostic factors alone or sperately presented their data..</p></div><div id="chi1.s9.1.3"><h5>1.9.1.3. Benefits and harms</h5><p>The data from the RCT provided evidence that ultrasound made no
|
|
clinical difference for any of the critical outcomes (disease
|
|
activity score, RAID score and quality of life) when compared to
|
|
monitoring without the use of ultrasound. Most of the important
|
|
outcomes (DAS remission, pain and withdrawal due to adverse
|
|
events) also failed to show a clinical difference between the
|
|
groups. The outcomes which did show limited benefit with the use
|
|
of ultrasound were associated with considerable uncertainty and
|
|
were inconsistent with the majority of the data that informed
|
|
the review. The committee therefore placed little weight on the
|
|
evidence for these outcomes in their deliberations.</p><p>The committee discussed the findings from the prognostic studies.
|
|
The committee could not reconcile the highly inconsistent
|
|
findings between the outcomes and even between different
|
|
ultrasound measures for the same outcome. For example, given the
|
|
association seen between grey scale inflammation and MRI erosive
|
|
progression, the committee were surprised to see no association
|
|
between the same factor and the outcomes of remission and
|
|
function.</p><p>The committee agreed that given the limited data (1 small study
|
|
for each outcome), the low to very low evidence quality, and the
|
|
inconsistent results across the outcomes, little weight should
|
|
be placed on the prognostic data in determining the value of
|
|
ultrasound in monitoring rheumatoid arthritis. The committee
|
|
agreed that RCT data was the best way to establish the true
|
|
added value of monitoring rheumatoid arthritis using ultrasound.
|
|
In the presence of the clear RCT findings, the committee placed
|
|
little weight on the (inconsistent, inconclusive) results of the
|
|
non-randomised prognostic studies.</p><p>Overall, the committee agreed that there was no evidence that
|
|
ultrasound added value over monitoring disease activity
|
|
clinically for the majority of rheumatoid arthritis patients. As
|
|
a result, the committee agreed that for most people with
|
|
rheumatoid arthritis, clinical assessment performs well and
|
|
there was no reason to recommend the use of ultrasound as it
|
|
does not provide additional information that would change
|
|
management or outcomes.</p><p>The committee decided that the evidence did not support the
|
|
routine use of ultrasound in monitoring the majority of people
|
|
with rheumatoid arthritis and made a recommendation
|
|
accordingly.</p><p>The committee agreed, however, that there may be a proportion of
|
|
people who might benefit from ultrasound assessment, but these
|
|
populations were not defined in any of the included studies.
|
|
These might be people with rheumatoid arthritis where decisions
|
|
have to be made about escalating treatment, and in whom: <ul id="l226"><li id="lt690" class="half_rhythm"><div>the clinician perceives a difference between the
|
|
clinical examination and the disease activity score
|
|
(for example, where no clinical synovitis is
|
|
apparent but other markers of disease activity such
|
|
as inflammatory markers or pain are high); or</div></li><li id="lt691" class="half_rhythm"><div>clinical examination is unreliable or uncertain (for
|
|
example, the evaluation of synovial swelling is
|
|
affected by other co-existent factors such as
|
|
obesity or oedema).</div></li></ul></p><p>The committee noted that the included studies did not solely
|
|
reflect the potential rheumatoid arthritis populationsof
|
|
interest, as stated above. Therefore, the committee agreed to
|
|
make a research recommendation to determine whether ultrasound
|
|
assessment would add value to standard clinical monitoring in
|
|
the specific RA populations.</p></div></div><div id="chi1.s9.2"><h4>1.9.2. Cost effectiveness and resource use</h4><p>No health economic studies were identified. The unit cost of
|
|
ultrasound (£55 per ultrasound) was presented to the
|
|
committee to aid the consideration of cost-effectiveness. The
|
|
committee noted that, in some areas ultrasound monitoring is carried
|
|
out in the rheumatology department and in other areas it is referred
|
|
to the radiology department. The unit cost presented to the
|
|
committee was deemed to reflect the cost of ultrasound within a
|
|
radiology department appropriately.</p><p>The committee discussed the potential economic benefits of ultrasound
|
|
monitoring in a subset of people. The committee noted that in this
|
|
subset of people in whom ultrasound monitoring could help to
|
|
identify remission, treatment could be tapered off, and there could
|
|
be a reduction in the use of DMARDs. This could potentially offset
|
|
the cost of monitoring or even save costs to the NHS. The committee
|
|
conceded that no evidence is currently available to support
|
|
this.</p><p>The clinical evidence did not support the routine use of ultrasound
|
|
in monitoring the majority of people with rheumatoid arthritis, and
|
|
the committee made a recommendation accordingly. As routine use of
|
|
ultrasound for monitoring is used in some rheumatology departments
|
|
in the NHS, it is anticipated that this recommendation should reduce
|
|
the overall use of ultrasound and therefore moderately reduce costs
|
|
to the NHS.</p></div><div id="chi1.s9.3"><h4>1.9.3. Other factors the committee took into account</h4><p>The committee discussed that results seen from ultrasound can be
|
|
meaningful for people with rheumatoid arthritis. The patient
|
|
representatives on the committee explained that ultrasound enables
|
|
patients to visualise their disease activity, instead of only been
|
|
given a score (for example, DAS). This may be reflected by data from
|
|
the RCT which showed that more people continued to be willing to
|
|
participate in the ultrasound treatment arm compared to the clinical
|
|
monitoring only arm (though the committee again noted the
|
|
imprecision of this effect estimate). In some circumstances, this
|
|
visualisation of disease activity may be important and may improve
|
|
patient outcomes, by encouraging medication adherence and
|
|
facilitating agreement to treatment escalation where necessary.
|
|
However, the committee agreed that in the presence of evidence that
|
|
including ultrasound as part of regular monitoring does not improve
|
|
clinical outcomes, its routine use could not be justified. Further
|
|
research should help to clarify the circumstances where ultrasound
|
|
assessment may be clinically and cost effective in rheumatoid
|
|
arthritis.</p></div></div></div><div id="pti.rl.r1"><h2 id="_pti_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="pti.ref1">Aydin
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SZ,
|
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Gunal
|
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EK,
|
|
Ozata
|
|
M,
|
|
Keskin
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H,
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|
Ozturk
|
|
AB,
|
|
Emery
|
|
P
|
|
et al. Six-joint ultrasound in rheumatoid arthritis: a
|
|
feasible approach for implementing ultrasound in
|
|
remission. Clinical and Experimental
|
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Rheumatology. 2017;
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16:16 [<a href="https://pubmed.ncbi.nlm.nih.gov/28628469" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28628469</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="pti.ref2">Backhaus
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TM,
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Ohrndorf
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S,
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|
Kellner
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H,
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Strunk
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J,
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Hartung
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W,
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Sattler
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H
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et al. The US7 score is sensitive to change in a large
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cohort of patients with rheumatoid arthritis over 12 months of
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therapy. Annals of the Rheumatic
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Diseases. 2013;
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72(7):1163–1169 [<a href="/pmc/articles/PMC3686255/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3686255</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22956596" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22956596</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="pti.ref3">Barlow
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JH,
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Barefoot
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J. Group
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education for people with arthritis. Patient
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Education and Counseling. 1996;
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27(3):257–267 [<a href="https://pubmed.ncbi.nlm.nih.gov/8788354" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8788354</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="pti.ref4">Bellis
|
|
E,
|
|
Scire
|
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CA,
|
|
Carrara
|
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G,
|
|
Adinolfi
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A,
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Batticciotto
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A,
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Bortoluzzi
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A
|
|
et al. Ultrasound-detected tenosynovitis independently
|
|
associates with patient-reported flare in patients with rheumatoid
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arthritis in clinical remission: results from the observational
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study STARTER of the Italian Society for
|
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Rheumatology. Rheumatology.
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2016;
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55(10):1826–1836 [<a href="https://pubmed.ncbi.nlm.nih.gov/27354688" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27354688</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="pti.ref5">Boyesen
|
|
P,
|
|
Haavardsholm
|
|
EA,
|
|
Van Der Heijde
|
|
D,
|
|
Ostergaard
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M,
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Hammer
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HB,
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Sesseng
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S
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et al. Prediction of MRI erosive progression: A
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comparison of modern imaging modalities in early rheumatoid
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arthritis patients. Annals of the Rheumatic
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Diseases. 2011;
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70(1):176–179 [<a href="https://pubmed.ncbi.nlm.nih.gov/21068093" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21068093</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="pti.ref6">Brown
|
|
AK,
|
|
Conaghan
|
|
PG,
|
|
Karim
|
|
Z,
|
|
Quinn
|
|
MA,
|
|
Ikeda
|
|
K,
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Peterfy
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CG
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et al. An explanation for the apparent dissociation
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between clinical remission and continued structural deterioration in
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rheumatoid arthritis. Arthritis &
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Rheumatism. 2008;
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58(10):2958–2967 [<a href="https://pubmed.ncbi.nlm.nih.gov/18821687" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18821687</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="pti.ref7">Bugatti
|
|
S,
|
|
Bogliolo
|
|
L,
|
|
Vitolo
|
|
B,
|
|
Manzo
|
|
A,
|
|
Montecucco
|
|
C,
|
|
Caporali
|
|
R.
|
|
Anti-citrullinated protein antibodies and high levels
|
|
of rheumatoid factor are associated with systemic bone loss in
|
|
patients with early untreated rheumatoid arthritis.
|
|
Arthritis Research & Therapy.
|
|
2016;
|
|
18:226 [<a href="/pmc/articles/PMC5052789/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5052789</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27716332" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27716332</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="pti.ref8">Bugatti
|
|
S,
|
|
Manzo
|
|
A,
|
|
Benaglio
|
|
F,
|
|
Klersy
|
|
C,
|
|
Vitolo
|
|
B,
|
|
Todoerti
|
|
M
|
|
et al. Serum levels of CXCL13 are associated with
|
|
ultrasonographic synovitis and predict power Doppler persistence in
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|
early rheumatoid arthritis treated with non-biological
|
|
disease-modifying anti-rheumatic drugs.
|
|
Arthritis Research & Therapy.
|
|
2012;
|
|
14:R34 [<a href="/pmc/articles/PMC3392832/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3392832</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22336440" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22336440</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="pti.ref9">Cavet
|
|
G,
|
|
Shen
|
|
Y,
|
|
Abraham
|
|
S,
|
|
Chernoff
|
|
D,
|
|
Centola
|
|
M,
|
|
Taylor
|
|
P.
|
|
Predicting radiographic progression in rheumatoid
|
|
arthritis with ultrasound and biomarkers.
|
|
Arthritis & Rheumatism. 2009;
|
|
60:(Suppl
|
|
10):1464</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="pti.ref10">Chen
|
|
YC,
|
|
Su
|
|
FM,
|
|
Hsu
|
|
SW,
|
|
Chen
|
|
JF,
|
|
Cheng
|
|
TT,
|
|
Lai
|
|
HM
|
|
et al. Predictor of hand radiological progression in
|
|
patients with rheumatoid arthritis receiving TNF antagonist therapy
|
|
by change in grayscale synovitis-a preliminary
|
|
study. Journal of Clinical
|
|
Rheumatology. 2017;
|
|
23(2):73–76 [<a href="/pmc/articles/PMC5325254/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5325254</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28212115" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28212115</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="pti.ref11">Cheung
|
|
P,
|
|
Mari
|
|
K,
|
|
Devauchelle
|
|
V,
|
|
Bentin
|
|
J,
|
|
Jousse-Joulin
|
|
S,
|
|
D’Agostino
|
|
MA
|
|
et al. Are tender joints better than synovitis to
|
|
predict structural damage in rheumatoid arthritis?
|
|
Arthritis & Rheumatology. 2014;
|
|
66:(Suppl
|
|
10):S602</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="pti.ref12">Cheung
|
|
PP,
|
|
Mari
|
|
K,
|
|
Devauchelle-Pensec
|
|
V,
|
|
Jousse-Joulin
|
|
S,
|
|
D’Agostino
|
|
MA,
|
|
Chales
|
|
G
|
|
et al. Predictive value of tender joints compared to
|
|
synovitis for structural damage in rheumatoid
|
|
arthritis. RMD Open.
|
|
2016;
|
|
2(1):e000205 [<a href="/pmc/articles/PMC4800805/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4800805</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27042336" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27042336</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="pti.ref13">Christensen
|
|
AW,
|
|
Rifbjerg-Madsen
|
|
S,
|
|
Christensen
|
|
R,
|
|
Dreyer
|
|
L,
|
|
Boesen
|
|
M,
|
|
Ellegaard
|
|
K
|
|
et al. Ultrasound Doppler but not temporal summation of
|
|
pain predicts DAS28 response in rheumatoid arthritis: a prospective
|
|
cohort study. Rheumatology.
|
|
2016;
|
|
55(6):1091–1098 [<a href="https://pubmed.ncbi.nlm.nih.gov/26983452" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26983452</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="pti.ref14">D’Agostino
|
|
MA,
|
|
Boers
|
|
M,
|
|
Wakefield
|
|
RJ,
|
|
Berner Hammer
|
|
H,
|
|
Vittecoq
|
|
O,
|
|
Filippou
|
|
G
|
|
et al. Exploring a new ultrasound score as a clinical
|
|
predictive tool in patients with rheumatoid arthritis starting
|
|
abatacept: results from the APPRAISE study.
|
|
RMD Open. 2016;
|
|
2(1):e000237 [<a href="/pmc/articles/PMC4860864/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4860864</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27175297" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27175297</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="pti.ref15">D’Agostino
|
|
MA,
|
|
Boers
|
|
M,
|
|
Wakefield
|
|
RJ,
|
|
Emery
|
|
P,
|
|
Conaghan
|
|
PG. Is it
|
|
time to revisit the role of ultrasound in rheumatoid arthritis
|
|
management?
|
|
Annals of the Rheumatic Diseases. 2017;
|
|
76(1):7–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/27941072" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27941072</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="pti.ref16">Dale
|
|
J,
|
|
Purves
|
|
D,
|
|
McConnachie
|
|
A,
|
|
McInnes
|
|
I,
|
|
Porter
|
|
D.
|
|
Tightening up? Impact of musculoskeletal ultrasound
|
|
disease activity assessment on early rheumatoid arthritis patients
|
|
treated using a treat to target strategy.
|
|
Arthritis Care & Research.
|
|
2014;
|
|
66(1):19–26 [<a href="https://pubmed.ncbi.nlm.nih.gov/24376248" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24376248</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="pti.ref17">Dale
|
|
J,
|
|
Stirling
|
|
A. Targeting
|
|
ultrasound remission in early rheumatoid arthritis: results of the
|
|
TaSER study, a randomised clinical trial.
|
|
Annals of the Rheumatic Diseases.
|
|
2016;
|
|
75(6):1043–1050 [<a href="https://pubmed.ncbi.nlm.nih.gov/27026689" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27026689</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="pti.ref18">Dougados
|
|
M,
|
|
Devauchelle-Pensec
|
|
V,
|
|
Ferlet
|
|
JF,
|
|
Jousse-Joulin
|
|
S,
|
|
D’Agostino
|
|
MA,
|
|
Backhaus
|
|
M
|
|
et al. Both clinical and ultrasonographic evaluation of
|
|
synovitis are relevant to predict subsequent radiological
|
|
deterioration in rheumatoid arthritis.
|
|
Annals of the Rheumatic Diseases.
|
|
2012; 71:(Suppl
|
|
3):610</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="pti.ref19">Dougados
|
|
M,
|
|
Devauchelle-Pensec
|
|
V,
|
|
Ferlet
|
|
JF,
|
|
Jousse-Joulin
|
|
S,
|
|
D’Agostino
|
|
MA,
|
|
Backhaus
|
|
M
|
|
et al. The ability of synovitis to predict structural
|
|
damage in rheumatoid arthritis: a comparative study between clinical
|
|
examination and ultrasound. Annals of the
|
|
Rheumatic Diseases. 2013;
|
|
72(5):665–671 [<a href="/pmc/articles/PMC3618684/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3618684</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22679298" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22679298</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="pti.ref20">El
|
|
Miedany
|
|
Y, El
|
|
Gaafary
|
|
M,
|
|
Youssef
|
|
S,
|
|
Ahmed
|
|
I,
|
|
Bahlas
|
|
S,
|
|
Hegazi
|
|
M
|
|
et al. Optimizing therapy in inflammatory arthritis:
|
|
prediction of relapse after tapering or stopping treatment for
|
|
rheumatoid arthritis patients achieving clinical and radiological
|
|
remission. Clinical Rheumatology.
|
|
2016;
|
|
35(12):2915–2923 [<a href="https://pubmed.ncbi.nlm.nih.gov/27658417" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27658417</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="pti.ref21">Fukae
|
|
J,
|
|
Tanimura
|
|
K,
|
|
Isobe
|
|
M,
|
|
Kitano
|
|
A,
|
|
Henmi
|
|
M,
|
|
Nakai
|
|
M
|
|
et al. Active synovitis in the presence of osteitis
|
|
predicts residual synovitis in patients with rheumatoid arthritis
|
|
with a clinical response to treatment.
|
|
International Journal of Rheumatic Diseases.
|
|
2016;
|
|
Epublication [<a href="https://pubmed.ncbi.nlm.nih.gov/28160411" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28160411</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="pti.ref22">Gartner
|
|
M,
|
|
Alasti
|
|
F,
|
|
Supp
|
|
G,
|
|
Mandl
|
|
P,
|
|
Smolen
|
|
JS,
|
|
Aletaha
|
|
D.
|
|
Persistence of subclinical sonographic joint activity
|
|
in rheumatoid arthritis in sustained clinical
|
|
remission. Annals of the Rheumatic
|
|
Diseases. 2015;
|
|
74(11):2050–2053 [<a href="https://pubmed.ncbi.nlm.nih.gov/25977561" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25977561</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="pti.ref23">Geng
|
|
Y,
|
|
Han
|
|
J,
|
|
Deng
|
|
X,
|
|
Zhang
|
|
Z. Deep
|
|
clinical remission: an optimised target in the management of
|
|
rheumatoid arthritis? Experience from an ultrasonography
|
|
study. Clinical and Experimental
|
|
Rheumatology. 2016;
|
|
34(4):581–586 [<a href="https://pubmed.ncbi.nlm.nih.gov/27050636" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27050636</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="pti.ref24">Haavardsholm
|
|
EA,
|
|
Aga
|
|
AB,
|
|
Olsen
|
|
IC,
|
|
Hammer
|
|
HB,
|
|
Uhlig
|
|
T,
|
|
Fremstad
|
|
H
|
|
et al. Aiming for remission in rheumatoid arthritis -
|
|
The ARCTIC Trial. Arthritis &
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Rheumatology. 2016;
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68:(Suppl
|
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10):10L</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="pti.ref25">Haavardsholm
|
|
EA,
|
|
Aga
|
|
AB,
|
|
Olsen
|
|
IC,
|
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Lillegraven
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S,
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Hammer
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HB,
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|
|
EA,
|
|
Boyesen
|
|
P,
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Ostergaard
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M,
|
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Schildvold
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A,
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Kvien
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TK. Magnetic
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|
HB,
|
|
Kvien
|
|
TK,
|
|
Terslev
|
|
L.
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|
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J,
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Geng
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Y,
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Deng
|
|
X,
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Zhang
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Z.
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Subclinical synovitis assessed by ultrasound predicts
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with clinical remission: A systematic review and
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|
|
H,
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Tekeoglu
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I,
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Kaban
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N,
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|
|
H,
|
|
Tekeoglu
|
|
I,
|
|
Takci
|
|
S,
|
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Kamanli
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A,
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Nas
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K,
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Harman
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S.
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Improvement of large-joint ultrasonographic synovitis
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results of a 12-month clinical and ultrasonographic follow-up study
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|
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A,
|
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Ogura
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T,
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Hayashi
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N,
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Takenaka
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H,
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|
|
SC,
|
|
Tan
|
|
AL,
|
|
Freeston
|
|
JE,
|
|
Wakefield
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RJ,
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Buch
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MH,
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Emery
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P.
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|
|
SC,
|
|
Tan
|
|
AL,
|
|
Wakefield
|
|
RJ,
|
|
Freeston
|
|
JE,
|
|
Buch
|
|
MH,
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Emery
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P.
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J,
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Hulejova
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H,
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Zavada
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J,
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M,
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Hanova
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P,
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|
J,
|
|
Zavada
|
|
J,
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Hanova
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|
P,
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Hulejova
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H,
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Klein
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M,
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A,
|
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Finucci
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A,
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Ceccarelli
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F,
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Perricone
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C,
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Iorgoveanu
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V,
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2015;
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54(10):1890–1896 [<a href="https://pubmed.ncbi.nlm.nih.gov/26070937" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26070937</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="pti.ref37">Ikeda
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K,
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Brown
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A,
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Conaghan
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P,
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Karim
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Z,
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Quinn
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M,
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2):95</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="pti.ref38">Ikeda
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K,
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Nakagomi
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D,
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Sanayama
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Y,
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Yamagata
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M,
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Okubo
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A.
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Rheumatism. 2012;
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64:(Suppl
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10):S50</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="pti.ref39">Ikeda
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K,
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Nakagomi
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D,
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Sanayama
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Y,
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Yamagata
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M,
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A,
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G,
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J,
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B.
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I,
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Valor
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L, De
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la Torre
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I,
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Martinez-Estupinan
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L,
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36(3):387–396 [<a href="https://pubmed.ncbi.nlm.nih.gov/26712373" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26712373</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="pti.ref42">Jeka
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S,
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Dura
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M,
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P,
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Zwierko
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B,
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S,
|
|
Kaushik
|
|
R,
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Raghuvanshi
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S,
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Kaushik
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RM,
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GG,
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Siagkri
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C,
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SR,
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HA,
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FA,
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SY,
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Nishino
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A,
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Shimizu
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T,
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Umeda
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M,
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Fukui
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S,
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|
Y,
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Hama
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|
M,
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Takase-Minegishi
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|
K,
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|
Kunishita
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Y,
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D,
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KR,
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Pinheiro
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MM,
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Petterle
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GS,
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Dos Santos
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MF,
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AR,
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A,
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Bugatti
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S,
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Benaglio
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|
F,
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Vitolo
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B,
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Klersy
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C,
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E,
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Collado
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P,
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Cruz
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A,
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Palop
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F,
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|
|
E,
|
|
Moller
|
|
I,
|
|
Cruz
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|
A,
|
|
Carmona
|
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L,
|
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Rheumatism. 2008;
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|
|
R,
|
|
Karateev
|
|
D,
|
|
Panasyuk
|
|
E,
|
|
Smirnov
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A,
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Lukina
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G,
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3):A755–756</div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="pti.ref55">Osipyants
|
|
R,
|
|
Karateev
|
|
D,
|
|
Panasyuk
|
|
E,
|
|
Smirnov
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A,
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Lukina
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|
|
J,
|
|
Ruíz-Esquide
|
|
V,
|
|
Celis
|
|
R,
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Cuervo
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A,
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|
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JD,
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Pilcher
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J,
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Heron
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|
C,
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Kiely
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|
PD. A
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Rheumatology. 2007;
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|
|
PPM,
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C,
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|
J,
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|
|
J,
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|
Ruta
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|
S,
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Saucedo
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C,
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Navarta
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|
|
B,
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Brown
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|
AK,
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|
Quinn
|
|
M,
|
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Karim
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Hensor
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EM,
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|
CA,
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|
Montecucco
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|
C,
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Codullo
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|
V,
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Epis
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O,
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Todoerti
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M,
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|
D,
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Grayer
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M,
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Fisher
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BA,
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Ho
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M,
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S,
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|
|
K,
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Horita
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N,
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Kobayashi
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K,
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R,
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YK,
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Allen
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JC, Jr.,
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Lye
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WK,
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Conaghan
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PG,
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PC,
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Steuer
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A,
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Gruber
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J,
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Cosgrove
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N,
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Ogasawara
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M,
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Gorai
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M,
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Matsuki
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Y,
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Yamada
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Y,
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Tamura
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M,
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Kirino
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|
Y,
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Sugiyama
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Y,
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Tsuchida
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N,
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L,
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Martinez-Estupinan
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L,
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Janta
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I,
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Nieto
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JC,
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|
Ven
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M,
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Kuijper
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TM,
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Gerards
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|
AH,
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Tchetverikov
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I,
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AE,
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V,
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Berghea
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F,
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Micu
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M,
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Varzaru
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L,
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Bojinca
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FA,
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Filippucci
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E,
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Gutierrez
|
|
M, Di
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Geso
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RJ,
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Freeston
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|
JE,
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Hensor
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|
EM,
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Bryer
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D,
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|
Y,
|
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Ogasawara
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|
M,
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|
Gorai
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|
M,
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Matsuki
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Y,
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|
|
R,
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|
Hama
|
|
M,
|
|
Minegishi
|
|
K,
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|
Kishimoto
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D,
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Watanabe
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|
|
R,
|
|
Hama
|
|
M,
|
|
Takase
|
|
K,
|
|
Ihata
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A,
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D,
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J,
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Hanova
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P,
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Hurnakova
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|
J,
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Szczukova
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19:5 [<a href="/pmc/articles/PMC5237153/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5237153</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28086960" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28086960</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>77.</dt><dd><div class="bk_ref" id="pti.ref77">Zhao
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|
CY,
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Jiang
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YX,
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Li
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JC,
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Xu
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ZH,
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|
|
arthritis</a><span class="small"> (PDF, 190K)</span></p><p id="pti.appa.et2"><a href="/books/NBK577152/bin/pti-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 15. Health economic review protocol</a><span class="small"> (PDF, 152K)</span></p></div><div id="pti.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied
|
|
with the methodology outlined in Developing NICE guidelines: the manual
|
|
2014, updated 2017. <a href="https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869</a></p><p><i>For more detailed information, please see the Methodology
|
|
Review</i>.</p><div id="pti.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P)
|
|
terms were combined with Intervention (I) and in some cases
|
|
Comparison (C) terms. Outcomes (O) are rarely used in search
|
|
strategies for interventions as these concepts may not be well
|
|
described in title, abstract or indexes and therefore difficult to
|
|
retrieve. Search filters were applied to the search where
|
|
appropriate.</p><p id="pti.appb.tab1"><a href="/books/NBK577152/table/pti.appb.tab1/?report=objectonly" target="object" rid-ob="figobptiappbtab1" class="figpopup">Table 16. Database date parameters and filters used</a></p><p id="pti.appb.tab2"><a href="/books/NBK577152/table/pti.appb.tab2/?report=objectonly" target="object" rid-ob="figobptiappbtab2" class="figpopup">Medline (Ovid) search terms</a></p><p id="pti.appb.tab3"><a href="/books/NBK577152/table/pti.appb.tab3/?report=objectonly" target="object" rid-ob="figobptiappbtab3" class="figpopup">Embase (Ovid) search terms</a></p><p id="pti.appb.tab4"><a href="/books/NBK577152/table/pti.appb.tab4/?report=objectonly" target="object" rid-ob="figobptiappbtab4" class="figpopup">Cochrane Library (Wiley) search terms</a></p></div><div id="pti.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search
|
|
relating to rheumatoid arthritis population in NHS Economic
|
|
Evaluation Database (NHS EED – this ceased to be updated
|
|
after March 2015) and the Health Technology Assessment database
|
|
(HTA) with no date restrictions. NHS EED and HTA databases are
|
|
hosted by the Centre for Research and Dissemination (CRD).
|
|
Additional searches were run on Medline and Embase for health
|
|
economics studies.</p><p id="pti.appb.tab5"><a href="/books/NBK577152/table/pti.appb.tab5/?report=objectonly" target="object" rid-ob="figobptiappbtab5" class="figpopup">Table 17. Database date parameters and filters used</a></p><p id="pti.appb.tab6"><a href="/books/NBK577152/table/pti.appb.tab6/?report=objectonly" target="object" rid-ob="figobptiappbtab6" class="figpopup">Medline (Ovid) search terms</a></p><p id="pti.appb.tab7"><a href="/books/NBK577152/table/pti.appb.tab7/?report=objectonly" target="object" rid-ob="figobptiappbtab7" class="figpopup">Embase (Ovid) search terms</a></p><p id="pti.appb.tab8"><a href="/books/NBK577152/table/pti.appb.tab8/?report=objectonly" target="object" rid-ob="figobptiappbtab8" class="figpopup">NHS EED and HTA (CRD) search terms</a></p></div></div><div id="pti.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="pti.appc.fig1"><a href="/books/NBK577152/figure/pti.appc.fig1/?report=objectonly" target="object" rid-ob="figobptiappcfig1" class="figpopup">Figure 1. Flow chart of clinical study selection for the review of
|
|
ultrasound monitoring</a></p></div><div id="pti.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="pti.appd.et3"><a href="/books/NBK577152/bin/pti-appd-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">D.1. Randomised controlled trials</a><span class="small"> (PDF, 216K)</span></p><p id="pti.appd.et4"><a href="/books/NBK577152/bin/pti-appd-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">D.2. Prognostic studies</a><span class="small"> (PDF, 210K)</span></p></div><div id="pti.appe"><h3>Appendix E. Forest plots</h3><div id="pti.appe.s1"><h4>E.1. Randomised controlled trial: Clinical assessment and ultrasound
|
|
versus clinical assessment alone</h4><p id="pti.appe.fig2"><a href="/books/NBK577152/figure/pti.appe.fig2/?report=objectonly" target="object" rid-ob="figobptiappefig2" class="figpopup">Figure 2. Change in Disease activity score (DAS28)</a></p><p id="pti.appe.fig3"><a href="/books/NBK577152/figure/pti.appe.fig3/?report=objectonly" target="object" rid-ob="figobptiappefig3" class="figpopup">Figure 3. Change in function (RAID score)</a></p><p id="pti.appe.fig4"><a href="/books/NBK577152/figure/pti.appe.fig4/?report=objectonly" target="object" rid-ob="figobptiappefig4" class="figpopup">Figure 4. Change in Quality of life (EQ-5D)</a></p><p id="pti.appe.fig5"><a href="/books/NBK577152/figure/pti.appe.fig5/?report=objectonly" target="object" rid-ob="figobptiappefig5" class="figpopup">Figure 5. Remission (DAS<1.6)</a></p><p id="pti.appe.fig6"><a href="/books/NBK577152/figure/pti.appe.fig6/?report=objectonly" target="object" rid-ob="figobptiappefig6" class="figpopup">Figure 6. Change in pain (VAS)</a></p><p id="pti.appe.fig7"><a href="/books/NBK577152/figure/pti.appe.fig7/?report=objectonly" target="object" rid-ob="figobptiappefig7" class="figpopup">Figure 7. Withdrawal from trial due to “no longer
|
|
willing”</a></p><p id="pti.appe.fig8"><a href="/books/NBK577152/figure/pti.appe.fig8/?report=objectonly" target="object" rid-ob="figobptiappefig8" class="figpopup">Figure 8. Withdrawal from trial due to adverse events</a></p></div><div id="pti.appe.s2"><h4>E.2. Prognostic studies: Effect of clinical and US prognostic factors
|
|
on various outcomes</h4><p>Note: All prognostic factors are displayed on the forest plots even
|
|
where odds ratios were not reported, as these factors were
|
|
considered by the studies. Where a study has its results listed as
|
|
‘Not estimable’ for a specific factor, that factor was
|
|
not independently associated with the outcome following
|
|
multivariable analysis.</p><p id="pti.appe.fig9"><a href="/books/NBK577152/figure/pti.appe.fig9/?report=objectonly" target="object" rid-ob="figobptiappefig9" class="figpopup">Figure 9. Clinical and US prognostic factors for MRI erosive
|
|
progression (dichotomous; at 1 year)</a></p><p id="pti.appe.fig10"><a href="/books/NBK577152/figure/pti.appe.fig10/?report=objectonly" target="object" rid-ob="figobptiappefig10" class="figpopup">Figure 10. Clinical and US prognostic factors for disease flare
|
|
(increase in disease activity requiring an initiation,
|
|
change or increase in therapy based on DAS28; dichotomous
|
|
– at 1 year)</a></p><p id="pti.appe.fig11"><a href="/books/NBK577152/figure/pti.appe.fig11/?report=objectonly" target="object" rid-ob="figobptiappefig11" class="figpopup">Figure 11. Clinical and US prognostic factors for relapse
|
|
(DAS28-ESR>2.6 following a period of clinical
|
|
remission; dichotomous – at 1 year)</a></p><p id="pti.appe.fig12"><a href="/books/NBK577152/figure/pti.appe.fig12/?report=objectonly" target="object" rid-ob="figobptiappefig12" class="figpopup">Figure 12. Clinical and US prognostic factors for remission
|
|
(DAS28-CRP4v <2.6; dichotomous – at1
|
|
year)</a></p><p id="pti.appe.fig13"><a href="/books/NBK577152/figure/pti.appe.fig13/?report=objectonly" target="object" rid-ob="figobptiappefig13" class="figpopup">Figure 13. Clinical and US prognostic factors for remission
|
|
(DAS44-CRP4v <1.6; dichotomous – at1
|
|
year)</a></p></div></div><div id="pti.appf"><h3>Appendix F. GRADE tables</h3><div id="pti.appf.s1"><h4>F.1. Randomised controlled trials</h4><p id="pti.appf.et5"><a href="/books/NBK577152/bin/pti-appf-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 18. Clinical evidence profile: Clinical assessment and
|
|
ultrasound versus clinical assessment alone</a><span class="small"> (PDF, 176K)</span></p></div><div id="pti.appf.s2"><h4>F.2. Prognostic studies</h4><p id="pti.appf.et6"><a href="/books/NBK577152/bin/pti-appf-et6.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 19. Clinical evidence profile: MRI erosive progression
|
|
(dichotomous - at 1 year)</a><span class="small"> (PDF, 150K)</span></p><p id="pti.appf.et7"><a href="/books/NBK577152/bin/pti-appf-et7.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 20. Clinical evidence profile: Disease flare (dichotomous
|
|
– at 1 year; increase in disease activity requiring
|
|
an initiation, change or increase in therapy based on
|
|
DAS28)</a><span class="small"> (PDF, 145K)</span></p><p id="pti.appf.et8"><a href="/books/NBK577152/bin/pti-appf-et8.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 21. Clinical evidence profile: Relapse (dichotomous –
|
|
at 1 year; DAS28-ESR>2.6 following a period of
|
|
clinical remission)</a><span class="small"> (PDF, 148K)</span></p><p id="pti.appf.et9"><a href="/books/NBK577152/bin/pti-appf-et9.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 22. Clinical evidence profile: Remission (dichotomous
|
|
– at 12 months; DAS28-CRP4v <2.6)</a><span class="small"> (PDF, 155K)</span></p><p id="pti.appf.et10"><a href="/books/NBK577152/bin/pti-appf-et10.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 23. Clinical evidence profile: Remission (dichotomous
|
|
– at 12 months; DAS44-CRP4v <1.6)</a><span class="small"> (PDF, 155K)</span></p><p id="pti.appf.et11"><a href="/books/NBK577152/bin/pti-appf-et11.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 24. Clinical evidence profile: Function (continuous –
|
|
HAQ score 12 months after prognostic variables were
|
|
measured)</a><span class="small"> (PDF, 152K)</span></p></div></div><div id="pti.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="pti.appg.fig14"><a href="/books/NBK577152/figure/pti.appg.fig14/?report=objectonly" target="object" rid-ob="figobptiappgfig14" class="figpopup">Figure 14. Flow chart of economic study selection for the
|
|
guideline</a></p></div><div id="pti.apph"><h3>Appendix H. Health economic evidence tables</h3><p>None.</p></div><div id="pti.appi"><h3>Appendix I. Excluded studies</h3><div id="pti.appi.s1"><h4>I.1. Excluded clinical studies</h4><p id="pti.appi.tab1"><a href="/books/NBK577152/table/pti.appi.tab1/?report=objectonly" target="object" rid-ob="figobptiappitab1" class="figpopup">Table 25. Studies excluded from the clinical review</a></p></div><div id="pti.appi.s2"><h4>I.2. Excluded health economic studies</h4><p id="pti.appi.tab2"><a href="/books/NBK577152/table/pti.appi.tab2/?report=objectonly" target="object" rid-ob="figobptiappitab2" class="figpopup">Table 26. Studies excluded from the health economic review</a></p></div></div><div id="pti.appj"><h3>Appendix J. Research recommendations</h3><div id="pti.appj.s1"><h4>J.1. Ultrasound to assess disease activity (monitoring) where clinical
|
|
examination is inconsistent or inconclusive</h4><p><b>Research question:</b> What is the clinical and cost
|
|
effectiveness of using ultrasound to monitor disease in adults with
|
|
RA when/where clinical examination is inconclusive or inconsistent
|
|
with other signs of disease activity?</p><p>
|
|
<b>Why this is important:</b>
|
|
</p><p>Rheumatoid arthritis is a chronic inflammatory condition which
|
|
requires regular review of disease activity to enable relevant
|
|
adjustments in management accordingly to achieve a target of
|
|
remission or low disease activity.</p><p>While some people in clinical remission have been found to have
|
|
subclinical inflammation or erosions on ultrasound examination,
|
|
randomised controlled evidence does not support using ultrasound for
|
|
this routine monitoring of RA. However, ultrasound may be useful in
|
|
assessing disease activity in a narrower subgroup of people with RA;
|
|
specifically, when clinical examination is inconclusive or is
|
|
inconsistent with other signs of disease activity (for example, pain
|
|
or markers of inflammation). Reliable research on the added value of
|
|
ultrasound in assessing disease activity as part of a monitoring
|
|
strategy in these subgroups is absent.</p><p>If clinical examination is unreliable or uncertain in this subgroup,
|
|
it will be challenging for healthcare professionals to make a valid
|
|
clinical assessment and thus apply a treat to target approach and
|
|
make appropriate management decisions.</p><p>In addition, where there is inconsistency between the clinical
|
|
examination and the disease activity score, it may be unclear if the
|
|
person has subclinical inflammatory synovitis or more of a
|
|
widespread pain syndrome, which is not inflammatory. These states
|
|
require very different treatments, so it is important to define them
|
|
accurately.</p><div id="pti.appj.s1.1"><h5>Criteria for selecting high-priority research
|
|
recommendations</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figptiappjtab1"><a href="/books/NBK577152/table/pti.appj.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figptiappjtab1" rid-ob="figobptiappjtab1"><img class="small-thumb" src="/books/NBK577152/table/pti.appj.tab1/?report=thumb" src-large="/books/NBK577152/table/pti.appj.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="pti.appj.tab1"><a href="/books/NBK577152/table/pti.appj.tab1/?report=objectonly" target="object" rid-ob="figobptiappjtab1">Table</a></h4><p class="float-caption no_bottom_margin">Population: Adults
|
|
with RA in whom clinical examination is
|
|
inconclusive or is inconsistent with other signs
|
|
of disease activity Intervention(s):
|
|
Treatment adjusted throughultrasound assessment
|
|
plus usual monitoring
|
|
assessments</p></div></div></div></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence review</p><p>Developed by the National Guideline Centre, hosted by the Royal College of
|
|
Physicians</p></div><div><p>The recommendations in this guideline represent the view of NICE, arrived at after
|
|
careful consideration of the evidence available. When exercising their judgement,
|
|
professionals are expected to take this guideline fully into account, alongside the
|
|
individual needs, preferences and values of their patients or service users. The
|
|
recommendations in this guideline are not mandatory and the guideline does not
|
|
override the responsibility of healthcare professionals to make decisions
|
|
appropriate to the circumstances of the individual patient, in consultation with the
|
|
patient and, where appropriate, their carer or guardian.</p><p>Local commissioners and providers have a responsibility to enable the guideline to be
|
|
applied when individual health professionals and their patients or service users
|
|
wish to use it. They should do so in the context of local and national priorities
|
|
for funding and developing services, and in light of their duties to have due regard
|
|
to the need to eliminate unlawful discrimination, to advance equality of opportunity
|
|
and to reduce health inequalities. Nothing in this guideline should be interpreted
|
|
in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in
|
|
other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and
|
|
<a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland
|
|
Executive</a>. All NICE guidance is subject to regular review and may be
|
|
updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2018.</div><div class="small"><span class="label">Bookshelf ID: NBK577152</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35129933" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35129933</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobchi1tab1"><div id="chi1.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of clinical effectivenss review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_chi1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chi1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with rheumatoid
|
|
arthritis</p>
|
|
<p>Studies in adults with poor
|
|
prognostic factors, patients in remission, and
|
|
patients with early disease (< 1 year) will
|
|
be presented separately</p>
|
|
</td></tr><tr><th id="hd_b_chi1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_chi1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l218"><li id="lt655" class="half_rhythm"><div>Clinical assessment plus ultrasound
|
|
assssment</div></li></ul></td></tr><tr><th id="hd_b_chi1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_chi1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l219"><li id="lt656" class="half_rhythm"><div>Clinical assessment alone</div></li></ul></td></tr><tr><th id="hd_b_chi1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_chi1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CRITICAL <ul id="l220"><li id="lt657" class="half_rhythm"><div>Disease Activity Score (continuous) at 12
|
|
months</div></li><li id="lt658" class="half_rhythm"><div>Quality of life (continuous) at 12 months</div></li><li id="lt659" class="half_rhythm"><div>Function (continuous) at 12 months</div></li></ul> IMPORTANT <ul id="l221"><li id="lt660" class="half_rhythm"><div>Remission (dichotomous) at 12 months</div></li><li id="lt661" class="half_rhythm"><div>Low disease activity (dichotomous) at 12
|
|
months</div></li><li id="lt662" class="half_rhythm"><div>Relapse (dichotomous) at 12 months</div></li><li id="lt663" class="half_rhythm"><div>Flare (dichotomous) at 12 months</div></li><li id="lt664" class="half_rhythm"><div>Pain (continuous) at 12 months</div></li><li id="lt665" class="half_rhythm"><div>Radiographic progression (continuous) at 12
|
|
months</div></li><li id="lt666" class="half_rhythm"><div>Change in planned management at time of testing
|
|
(dichotomous) over duration of trial</div></li><li id="lt667" class="half_rhythm"><div>Withdrawal from trial / adherence to strategy
|
|
(dichotomous) over duration of trial</div></li></ul></td></tr><tr><th id="hd_b_chi1.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_chi1.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Randomised controlled
|
|
trials (RCTs)</p>
|
|
<p>Systematic Review / Network
|
|
Meta-Analysis of RCTs</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchi1tab2"><div id="chi1.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">PICO characteristics of prognostic question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab2_lrgtbl__"><table><tbody><tr><th id="hd_b_chi1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chi1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with
|
|
RA.</p>
|
|
<p>Studies in adults with poor prognostic
|
|
factors, patients in remission, and patients with
|
|
early disease (< 1 year) will be presented
|
|
separately.</p>
|
|
</td></tr><tr><th id="hd_b_chi1.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prognostic factor(s)</th><td headers="hd_b_chi1.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prognostic factors: <ul id="l222"><li id="lt668" class="half_rhythm"><div>Ultrasound findings (for example: synovitis,
|
|
persistent effusion, tendon injuries, synovitis,
|
|
Doppler flow, tethering of the tendons, ligament,
|
|
tenosynovitis, erosions)</div></li><li id="lt669" class="half_rhythm"><div>Disease activity</div></li></ul></td></tr><tr><th id="hd_b_chi1.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome(s)</th><td headers="hd_b_chi1.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l223"><li id="lt670" class="half_rhythm"><div>Disease Activity Score (continuous)</div></li><li id="lt671" class="half_rhythm"><div>Quality of life (continuous)</div></li><li id="lt672" class="half_rhythm"><div>Function (continuous)</div></li><li id="lt673" class="half_rhythm"><div>Remission (dichotomous)</div></li><li id="lt674" class="half_rhythm"><div>Low disease activity (dichotomous)</div></li><li id="lt675" class="half_rhythm"><div>Relapse (dichotomous)</div></li><li id="lt676" class="half_rhythm"><div>Flare (dichotomous)</div></li><li id="lt677" class="half_rhythm"><div>Pain (continuous)</div></li><li id="lt678" class="half_rhythm"><div>Radiographic progression (continuous)</div></li><li id="lt679" class="half_rhythm"><div>Change in planned management at time of testing
|
|
(dichotomous)</div></li><li id="lt680" class="half_rhythm"><div>Withdrawal from trial / adherence to strategy
|
|
(dichotomous)</div></li></ul></td></tr><tr><th id="hd_b_chi1.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_chi1.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Prospective cohort studies
|
|
(prognostic)</p>
|
|
<p>Systematic reviews of the
|
|
above</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchi1tab3"><div id="chi1.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary of randomised controlled trials included in the
|
|
evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_chi1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_chi1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and
|
|
comparison</th><th id="hd_h_chi1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_chi1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_chi1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Haavardsh olm 2016<a class="bibr" href="#pti.ref25" rid="pti.ref25"><sup>25</sup></a></td><td headers="hd_h_chi1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Monitoring of
|
|
treat-to-target tight control regime using
|
|
clinical assessment and ultrasound versus
|
|
monitoring using clinical assessment alone (usual
|
|
care).</p>
|
|
<p>
|
|
<u>US
|
|
Group:</u>
|
|
</p>
|
|
<p>Target was clinical
|
|
remission (DAS <1.6 and no swollen joints)
|
|
and no power Doppler (PD) signal in any of the
|
|
joints assessed.</p>
|
|
<p>
|
|
<u>Control
|
|
group:</u>
|
|
</p>
|
|
<p>Target was clinical
|
|
remission (DAS < 1.6 and no swollen
|
|
joints).</p>
|
|
</td><td headers="hd_h_chi1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults aged 18-75 years
|
|
with early RA</p>
|
|
<p>n=238</p>
|
|
</td><td headers="hd_h_chi1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l224"><li id="lt681" class="half_rhythm"><div>Disease activity score</div></li><li id="lt682" class="half_rhythm"><div>Rheumatoid Arthritis Impact of Disease (RAID)
|
|
score</div></li><li id="lt683" class="half_rhythm"><div>Quality of life (EQ-5D)</div></li><li id="lt684" class="half_rhythm"><div>Remission</div></li><li id="lt685" class="half_rhythm"><div>Pain</div></li><li id="lt686" class="half_rhythm"><div>Radiological progression</div></li><li id="lt687" class="half_rhythm"><div>Withdrawal from trial due to “no longer
|
|
willing”</div></li><li id="lt688" class="half_rhythm"><div>Withdrawal from trial due to adverse events</div></li></ul></td><td headers="hd_h_chi1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Participants in both
|
|
groups were treated according to the same fixed
|
|
treatment algorithm, adhering to a treat-to-target
|
|
strategy with DMARD escalation therapy if target was
|
|
not met. US results could be used by clinicians to
|
|
overrule DAS-based target decisions if
|
|
indicated.</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchi1tab4"><div id="chi1.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Summary of prospective cohort prognostic studies included
|
|
in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_chi1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_chi1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Analysis</th><th id="hd_h_chi1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Prognostic
|
|
variable(s)</th><th id="hd_h_chi1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Confounders</th><th id="hd_h_chi1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcome</th><th id="hd_h_chi1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Limitations</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Boyesen 2011<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>5</sup></a>;</p>
|
|
<p>Haavar dsholm
|
|
2008<a class="bibr" href="#pti.ref26" rid="pti.ref26"><sup>26</sup></a></p>
|
|
</td><td headers="hd_h_chi1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with early
|
|
rheumatoid arthritis (<1 year)</p>
|
|
<p>n =
|
|
84</p>
|
|
</td><td headers="hd_h_chi1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stepwise multiple logistic
|
|
regression</td><td headers="hd_h_chi1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>USGS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a></p>
|
|
<p>inflammation, DAS28,
|
|
anti-CCP+, SvdH score<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a></p>
|
|
</td><td headers="hd_h_chi1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All prognostic variables
|
|
plus an additional eleven clinical, biomarker and
|
|
demographic variables</td><td headers="hd_h_chi1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic resonance imaging
|
|
(MRI) erosive progression</td><td headers="hd_h_chi1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low risk of bias</td></tr><tr><td headers="hd_h_chi1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Geng 2016<a class="bibr" href="#pti.ref23" rid="pti.ref23"><sup>23</sup></a></td><td headers="hd_h_chi1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with rheumatoid
|
|
arthritis in clinical remission</p>
|
|
<p>n =
|
|
126</p>
|
|
</td><td headers="hd_h_chi1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multivariable logistic
|
|
regression</td><td headers="hd_h_chi1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DAS28-ESR<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>3</sup></a>, PD<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>4</sup></a>>0, PD
|
|
total score and SH<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>5</sup></a> total
|
|
score</td><td headers="hd_h_chi1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Additional variables
|
|
included in univariate analysis not known</td><td headers="hd_h_chi1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relapse (DAS28-ESR
|
|
> 2.6)</td><td headers="hd_h_chi1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very high risk of bias
|
|
(outcome measurement – blinding not reported;
|
|
statistical analysis and reporting –
|
|
univariate analysis (UVA) analysis not reported and
|
|
multivariate analysis (MVA) model unclear).</td></tr><tr><td headers="hd_h_chi1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Horton 2016<a class="bibr" href="#pti.ref32" rid="pti.ref32"><sup>32</sup></a></td><td headers="hd_h_chi1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with rheumatoid
|
|
arthritis (DAS28-CRP4v ≥2.6)</p>
|
|
<p>n =
|
|
217</p>
|
|
</td><td headers="hd_h_chi1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multivariable logistic
|
|
regression</td><td headers="hd_h_chi1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TJC28<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>6</sup></a>, SJC28<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>7</sup></a>, CRP<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>8</sup></a> mg/L,
|
|
patient VASglobal disease assessment (components of
|
|
DAS28-CRP), total USGS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a> score on US,
|
|
total PD<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>4</sup></a> activity (PDA) score</td><td headers="hd_h_chi1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All prognostic variables
|
|
plus an additional eleven clinical, biomarker and
|
|
demographic variables</td><td headers="hd_h_chi1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Remission: both
|
|
DAS28-CRP4v < 2.6 and DAS44-CRP4v <
|
|
1.6</td><td headers="hd_h_chi1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very high risk of bias
|
|
(study attrition – 52% patients lost to
|
|
follow up or excluded; outcome measurement –
|
|
blinding not reported; statistical analysis and
|
|
reporting – only included variables in MVA if
|
|
p < 0.05 in UVA, may have missed important
|
|
variables).</td></tr><tr><td headers="hd_h_chi1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saleem 2012<a class="bibr" href="#pti.ref60" rid="pti.ref60"><sup>60</sup></a></td><td headers="hd_h_chi1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with rheumatoid
|
|
arthritis in remission (no flares in the last 6
|
|
months, stable treatment)</p>
|
|
<p>n = 93</p>
|
|
</td><td headers="hd_h_chi1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiple binary logistic
|
|
regression</td><td headers="hd_h_chi1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PD<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>4</sup></a> present, remission
|
|
(DAS28<2.6)</td><td headers="hd_h_chi1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All prognostic variables
|
|
plus health assessment questionnaire disability
|
|
index (HAQ-DI)</td><td headers="hd_h_chi1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Disease flare</td><td headers="hd_h_chi1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very high risk of bias
|
|
(study attrition- no information on drop-outs;
|
|
prognostic factor measurement- crudemeasurement;
|
|
study confounding- few possible confounders
|
|
accounted for)</td></tr><tr><td headers="hd_h_chi1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zavada 2017<a class="bibr" href="#pti.ref76" rid="pti.ref76"><sup>76</sup></a></td><td headers="hd_h_chi1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with early or
|
|
established rheumatoid arthritis</p>
|
|
<p>n =
|
|
185</p>
|
|
</td><td headers="hd_h_chi1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiple logistic
|
|
regression</td><td headers="hd_h_chi1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Previous DAS28-CRP<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>8</sup></a> and previous US
|
|
assessment</p>
|
|
<p>(GSsynSS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>9</sup></a>,
|
|
PDsynSS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>10</sup></a>,
|
|
GStenSS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>11</sup></a>,
|
|
PDtenSS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>12</sup></a>, erosion
|
|
score (ES)</p>
|
|
</td><td headers="hd_h_chi1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All prognostic variables
|
|
plus previous HAQ</td><td headers="hd_h_chi1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HAQ score (after measuring
|
|
prognostic variables)</td><td headers="hd_h_chi1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>High risk of bias
|
|
(study attrition- missing data
|
|
unclear)</p>
|
|
<p>Serious indirectness (MVA model
|
|
looks at associations between different time
|
|
points rather than baseline to 12 months)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chi1.tab4_1"><p class="no_margin">Ultrasound grey-scale</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chi1.tab4_2"><p class="no_margin">Sharp van der Heijde score</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chi1.tab4_3"><p class="no_margin">Erythrocyte sedimentation rate</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="chi1.tab4_4"><p class="no_margin">Power Doppler</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="chi1.tab4_5"><p class="no_margin">synovial hypertrophy</p></div></dd></dl><dl class="bkr_refwrap"><dt>6</dt><dd><div id="chi1.tab4_6"><p class="no_margin">Tender joint count of 28 joints</p></div></dd></dl><dl class="bkr_refwrap"><dt>7</dt><dd><div id="chi1.tab4_7"><p class="no_margin">Swollen joint count of 28 joints</p></div></dd></dl><dl class="bkr_refwrap"><dt>8</dt><dd><div id="chi1.tab4_8"><p class="no_margin">C-reactive protein</p></div></dd></dl><dl class="bkr_refwrap"><dt>9</dt><dd><div id="chi1.tab4_9"><p class="no_margin">Grey-scale synovitis sum score</p></div></dd></dl><dl class="bkr_refwrap"><dt>10</dt><dd><div id="chi1.tab4_10"><p class="no_margin">Power Doppler synovitis sum score</p></div></dd></dl><dl class="bkr_refwrap"><dt>11</dt><dd><div id="chi1.tab4_11"><p class="no_margin">Grey-scale tenosynovitis sum score</p></div></dd></dl><dl class="bkr_refwrap"><dt>12</dt><dd><div id="chi1.tab4_12"><p class="no_margin">Power Doppler tenosynovitis sum score</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchi1tab5"><div id="chi1.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: clinical assessment and
|
|
ultrasound versus clinical assessment alone</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_chi1.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_chi1.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_chi1.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of
|
|
Participants (studies) Follow up</th><th id="hd_h_chi1.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_chi1.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality
|
|
of the evidence (GRADE)</th><th id="hd_h_chi1.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_chi1.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_chi1.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_chi1.tab5_1_1_1_5" id="hd_h_chi1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with
|
|
Control</th><th headers="hd_h_chi1.tab5_1_1_1_5" id="hd_h_chi1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference
|
|
with Monitoring including ultrasound (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Disease Activity
|
|
Score</p>
|
|
<p>Change in DAS28. Scale from: 0 to
|
|
9.4.</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>230</p>
|
|
<p>(1
|
|
study)</p>
|
|
<p>12 months</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a></p>
|
|
<p>due to risk of
|
|
bias</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean change in
|
|
Disease Activity Score in the control groups was
|
|
−2.4</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean change in
|
|
Disease Activity Score in the intervention groups
|
|
was</p>
|
|
<p>0 higher</p>
|
|
<p>(0.35 lower to 0.35
|
|
higher)</p>
|
|
</td></tr><tr><td headers="hd_h_chi1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Function</p>
|
|
<p>Change in rheumatoid arthritis
|
|
impact of disease (RAID) score. Scale from: 0 to
|
|
10.</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>230</p>
|
|
<p>(1
|
|
study)</p>
|
|
<p>12 months</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a></p>
|
|
<p>due to risk of
|
|
bias</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean change in
|
|
rheumatoid arthritis impact of disease score in
|
|
the control groups was −2.4</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean change in
|
|
rheumatoid arthritis impact of disease score in
|
|
the intervention groups was</p>
|
|
<p>0.2
|
|
lower</p>
|
|
<p>(0.76 lower to 0.36 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_chi1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of
|
|
life</p>
|
|
<p>Change in EQ-5D. Scale from:
|
|
−0.59 to 1.</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>230</p>
|
|
<p>(1
|
|
study)</p>
|
|
<p>12 months</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a></p>
|
|
<p>due to risk of
|
|
bias</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean change in
|
|
quality of life in the control groups was
|
|
0.25</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean change in
|
|
quality of life in the intervention groups
|
|
was</p>
|
|
<p>0.03 higher</p>
|
|
<p>(0.04 lower to 0.1
|
|
higher)</p>
|
|
</td></tr><tr><td headers="hd_h_chi1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Remission</p>
|
|
<p>DAS
|
|
<1.6</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>230</p>
|
|
<p>(1
|
|
study)</p>
|
|
<p>12 months</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a><sup>,</sup><a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a></p>
|
|
<p>due to risk of bias,
|
|
imprecision</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.89</p>
|
|
<p>(0.75
|
|
to 1.06)</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">723 per 1000</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>80 fewer per
|
|
1000</p>
|
|
<p>(from 181 fewer to 43 more)</p>
|
|
</td></tr><tr><td headers="hd_h_chi1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Pain</p>
|
|
<p>Change
|
|
in VAS. Scale from: 0 to 100.</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>230</p>
|
|
<p>(1
|
|
study)</p>
|
|
<p>12 months</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a></p>
|
|
<p>due to risk of
|
|
bias</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean change in
|
|
pain in the control groups was −29.2</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean change in
|
|
pain in the intervention groups was</p>
|
|
<p>3.3
|
|
lower</p>
|
|
<p>(10.16 lower to 3.56 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_chi1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Radiological
|
|
progression</p>
|
|
<p>Change in Sharp score. Scale
|
|
from: 0 to 448.</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>230</p>
|
|
<p>(1
|
|
study)</p>
|
|
<p>24 months</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>3</sup></a></td><td headers="hd_h_chi1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The median
|
|
(interquartile range - IQR) change in Sharp score
|
|
in the control group was 1.5 (0.5-3.0)</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The median change
|
|
in Sharp score in the intervention groups
|
|
was</p>
|
|
<p>0.5 lower<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>4</sup></a> (median
|
|
(IQR): 1.0 (0-2.5)</p>
|
|
</td></tr><tr><td headers="hd_h_chi1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Withdrawal from trial
|
|
due to “no longer willing”</td><td headers="hd_h_chi1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>211</p>
|
|
<p>(1
|
|
study)</p>
|
|
<p>24 months</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a><sup>,</sup><a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a></p>
|
|
<p>due to risk of bias,
|
|
imprecision</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.4</p>
|
|
<p>(0.08
|
|
to 2)</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48 per 1000</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>29 fewer per
|
|
1000</p>
|
|
<p>(from 44 fewer to 48 more)</p>
|
|
</td></tr><tr><td headers="hd_h_chi1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Withdrawal from trial
|
|
due to adverse events</td><td headers="hd_h_chi1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>215</p>
|
|
<p>(1
|
|
study)</p>
|
|
<p>24 months</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a><sup>,</sup><a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a></p>
|
|
<p>due to risk of bias,
|
|
imprecision</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.15</p>
|
|
<p>(0.36
|
|
to 3.64)</p>
|
|
</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48 per 1000</td><td headers="hd_h_chi1.tab5_1_1_1_5 hd_h_chi1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>7 more per
|
|
1000</p>
|
|
<p>(from 30 fewer to 126 more)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chi1.tab5_1"><p class="no_margin">Downgraded by 1 increment if the majority of the
|
|
evidence was at high risk of bias, and downgraded by
|
|
2 increments if the majority of the evidence was at
|
|
very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chi1.tab5_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval
|
|
crossed one MID or by 2 increments if the confidence
|
|
interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chi1.tab5_3"><p class="no_margin">Imprecision could not be assessed because
|
|
non-parametric statistics were reported. The
|
|
confidence interval is relatively wide.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="chi1.tab5_4"><p class="no_margin">Confidence intervals not calculated due to
|
|
non-parametric statistics</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchi1tab6"><div id="chi1.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary - Outcome: MRI erosive
|
|
progression (dichotomous – at 1 year)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factor for
|
|
predicting MRI erosive progression</th><th id="hd_h_chi1.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of studies</th><th id="hd_h_chi1.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect (95% CI)</th><th id="hd_h_chi1.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>3</sup></a></th><th id="hd_h_chi1.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE Quality</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">USGS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a> inflammation (<0.5 vs
|
|
≥0.5)</td><td headers="hd_h_chi1.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=84)</td><td headers="hd_h_chi1.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjusted OR: 2.01
|
|
(1.14-3.53)</td><td headers="hd_h_chi1.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_chi1.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td></tr><tr><td headers="hd_h_chi1.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DAS28</td><td headers="hd_h_chi1.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=84)</td><td headers="hd_h_chi1.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr><tr><td headers="hd_h_chi1.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anti-CCP+</td><td headers="hd_h_chi1.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=84)</td><td headers="hd_h_chi1.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr><tr><td headers="hd_h_chi1.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sharp van der Heijde
|
|
score</td><td headers="hd_h_chi1.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=84)</td><td headers="hd_h_chi1.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">n/a: unable to assess as data not reported (factor not
|
|
independently associated with the outcome following
|
|
multivariable analysis)</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chi1.tab6_1"><p class="no_margin">USGS: Ultrasound grey-scale</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chi1.tab6_2"><p class="no_margin">If the 95% CI did not cross the null line then no
|
|
serious imprecision was recorded. If the 95% CI
|
|
crossed the null line then serious imprecision was
|
|
recorded.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchi1tab7"><div id="chi1.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary - Outcome: Disease flare
|
|
(increase in disease activity requiring an initiation,
|
|
change or increase in therapy based on DAS28;
|
|
dichotomous – at 1 year)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factor for
|
|
predicting disease flare</th><th id="hd_h_chi1.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of studies</th><th id="hd_h_chi1.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect (95% CI)</th><th id="hd_h_chi1.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a></th><th id="hd_h_chi1.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE Quality</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Remission
|
|
(DAS28<2.6)</td><td headers="hd_h_chi1.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=93)</td><td headers="hd_h_chi1.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjusted OR: 2.71
|
|
(0.73-10.14)</td><td headers="hd_h_chi1.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_chi1.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_chi1.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PD<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a> present</td><td headers="hd_h_chi1.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=93)</td><td headers="hd_h_chi1.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjusted OR: 7.57
|
|
(1.75-32.76)</td><td headers="hd_h_chi1.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_chi1.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chi1.tab7_1"><p class="no_margin">Power Doppler</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chi1.tab7_2"><p class="no_margin">If the 95% CI did not cross the null line then no
|
|
serious imprecision was recorded. If the 95% CI
|
|
crossed the null line then serious imprecision was
|
|
recorded.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchi1tab8"><div id="chi1.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Clinical evidence summary - Outcome: Relapse
|
|
(dichotomous – at 1 year; DAS28-ESR>2.6
|
|
following a period of clinical remission)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factor for
|
|
predicting relapse</th><th id="hd_h_chi1.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of studies</th><th id="hd_h_chi1.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect (95% CI)</th><th id="hd_h_chi1.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>4</sup></a></th><th id="hd_h_chi1.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE Quality</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PD<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a>>0</td><td headers="hd_h_chi1.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=126)</td><td headers="hd_h_chi1.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjusted OR: 8.8 (2.7
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|
– 28.4)</td><td headers="hd_h_chi1.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_chi1.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_chi1.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PD<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a> total score</td><td headers="hd_h_chi1.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=126)</td><td headers="hd_h_chi1.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjusted OR: 1.4 (0.9
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|
– 2.0)</td><td headers="hd_h_chi1.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_chi1.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_chi1.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SH<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>3</sup></a> total score</td><td headers="hd_h_chi1.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=126)</td><td headers="hd_h_chi1.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjusted OR: 0.7 (0.5
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|
– 1.0)</td><td headers="hd_h_chi1.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_chi1.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_chi1.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DAS28-ESR</td><td headers="hd_h_chi1.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=126)</td><td headers="hd_h_chi1.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data unavailable<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a></td><td headers="hd_h_chi1.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not assessed</td><td headers="hd_h_chi1.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not assessed</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chi1.tab8_1"><p class="no_margin">Variable was independently associated with the
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|
outcome but data is not presented here as it was
|
|
incorrectly reported by the authors.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chi1.tab8_2"><p class="no_margin">Power Doppler</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chi1.tab8_3"><p class="no_margin">Synovial hypertrophy</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="chi1.tab8_4"><p class="no_margin">If the 95% CI did not cross the null line then no
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|
serious imprecision was recorded. If the 95% CI
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|
crossed the null line then serious imprecision was
|
|
recorded.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchi1tab9"><div id="chi1.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Clinical evidence summary - Outcome: Remission
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|
(DAS28-CRP4v <2.6; dichotomous – at 1
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|
year)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factor for
|
|
predicting remission</th><th id="hd_h_chi1.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of studies</th><th id="hd_h_chi1.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect (95% CI)</th><th id="hd_h_chi1.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>6</sup></a></th><th id="hd_h_chi1.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE Quality</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CRP<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a> mg/l</td><td headers="hd_h_chi1.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr><tr><td headers="hd_h_chi1.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Patient VAS global
|
|
disease assessment</td><td headers="hd_h_chi1.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjusted OR: 0.98
|
|
(0.95 – 1.00)</td><td headers="hd_h_chi1.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_chi1.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_chi1.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SJC28<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a></td><td headers="hd_h_chi1.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr><tr><td headers="hd_h_chi1.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TJC28<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>3</sup></a></td><td headers="hd_h_chi1.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjusted OR: 0.93
|
|
(0.85 – 1.02)</td><td headers="hd_h_chi1.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_chi1.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_chi1.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total USGS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>4</sup></a> score on US</td><td headers="hd_h_chi1.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr><tr><td headers="hd_h_chi1.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total PDA<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>5</sup></a> score on US</td><td headers="hd_h_chi1.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">n/a: unable to assess as data not reported (factor not
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independently associated with the outcome following
|
|
multivariable analysis)</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chi1.tab9_1"><p class="no_margin">C-reactive protein</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chi1.tab9_2"><p class="no_margin">Tender joint count of 28 joints</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chi1.tab9_3"><p class="no_margin">Swollen joint count of 28 joints</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="chi1.tab9_4"><p class="no_margin">Ultrasound grey-scale</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="chi1.tab9_5"><p class="no_margin">Power Doppler Activity</p></div></dd></dl><dl class="bkr_refwrap"><dt>6</dt><dd><div id="chi1.tab9_6"><p class="no_margin">If the 95% CI did not cross the null line then no
|
|
serious imprecision was recorded. If the 95% CI
|
|
crossed the null line then serious imprecision was
|
|
recorded.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchi1tab10"><div id="chi1.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">Clinical evidence summary - Outcome: Remission
|
|
(DAS44-CRP4v <1.6; dichotomous – at 1
|
|
year)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab10_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factor for
|
|
predicting remission</th><th id="hd_h_chi1.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of studies</th><th id="hd_h_chi1.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect (95% CI)</th><th id="hd_h_chi1.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>6</sup></a></th><th id="hd_h_chi1.tab10_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE Quality</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CRP<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a> mg/l</td><td headers="hd_h_chi1.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab10_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr><tr><td headers="hd_h_chi1.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Patient VAS global
|
|
disease assessment</td><td headers="hd_h_chi1.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab10_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr><tr><td headers="hd_h_chi1.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SJC28<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a></td><td headers="hd_h_chi1.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab10_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr><tr><td headers="hd_h_chi1.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TJC28<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>3</sup></a></td><td headers="hd_h_chi1.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjusted OR: 0.88
|
|
(0.79 – 0.98)</td><td headers="hd_h_chi1.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_chi1.tab10_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_chi1.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total USGS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>4</sup></a> score</td><td headers="hd_h_chi1.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab10_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr><tr><td headers="hd_h_chi1.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total PDA<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>5</sup></a> score on US</td><td headers="hd_h_chi1.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=217)</td><td headers="hd_h_chi1.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not independently
|
|
associated with the outcome following
|
|
multivariable analysis.</td><td headers="hd_h_chi1.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chi1.tab10_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">n/a: unable to assess as data not reported (factor not
|
|
independently associated with the outcome following
|
|
multivariable analysis)</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chi1.tab10_1"><p class="no_margin">C-reactive protein</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chi1.tab10_2"><p class="no_margin">Tender joint count of 28 joints</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chi1.tab10_3"><p class="no_margin">Swollen joint count of 28 joints</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="chi1.tab10_4"><p class="no_margin">Ultrasound grey-scale</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="chi1.tab10_5"><p class="no_margin">Power Doppler Activity</p></div></dd></dl><dl class="bkr_refwrap"><dt>6</dt><dd><div id="chi1.tab10_6"><p class="no_margin">If the 95% CI did not cross the null line then no
|
|
serious imprecision was recorded. If the 95% CI
|
|
crossed the null line then serious imprecision was
|
|
recorded.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchi1tab11"><div id="chi1.tab11" class="table"><h3><span class="label">Table 11</span><span class="title">Clinical evidence summary - Outcome: Function (HAQ
|
|
score; continuous – 1 year after prognostic
|
|
variables were measured)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab11_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factor for
|
|
predicting function (at 12 months)</th><th id="hd_h_chi1.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of studies</th><th id="hd_h_chi1.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect (95% CI)</th><th id="hd_h_chi1.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>5</sup></a></th><th id="hd_h_chi1.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE Quality</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Previous
|
|
DAS28-CRP</td><td headers="hd_h_chi1.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=185)</td><td headers="hd_h_chi1.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Coefficient: 0.161
|
|
(0.113 to 0.208)</td><td headers="hd_h_chi1.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_chi1.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_chi1.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Previous GSsynSS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>2</sup></a></td><td headers="hd_h_chi1.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=185)</td><td headers="hd_h_chi1.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Coefficient:
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|
−0.004 (−0.019 to 0.010)</td><td headers="hd_h_chi1.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_chi1.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_chi1.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Previous PDsynSS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>1</sup></a></td><td headers="hd_h_chi1.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=185)</td><td headers="hd_h_chi1.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Coefficient:
|
|
−0.021 (−0.040 to
|
|
−0.002)</td><td headers="hd_h_chi1.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_chi1.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_chi1.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Previous GStenSS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>3</sup></a></td><td headers="hd_h_chi1.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=185)</td><td headers="hd_h_chi1.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Coefficient: 0.000
|
|
(−0.085 to 0.085)</td><td headers="hd_h_chi1.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_chi1.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_chi1.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Previous PDtenSS<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>4</sup></a></td><td headers="hd_h_chi1.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=185)</td><td headers="hd_h_chi1.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Coefficient:
|
|
−0.015 (−0.078 to 0.048)</td><td headers="hd_h_chi1.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_chi1.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_chi1.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Previous erosion
|
|
score</td><td headers="hd_h_chi1.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (n=185)</td><td headers="hd_h_chi1.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Coefficient: 0.012
|
|
(−0.022 to 0.046)</td><td headers="hd_h_chi1.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_chi1.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chi1.tab11_1"><p class="no_margin">Power Doppler synovitis sum score</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chi1.tab11_2"><p class="no_margin">Grey-scale synovitissum score</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chi1.tab11_3"><p class="no_margin">Grey-scale tenosynovitis sum score</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="chi1.tab11_4"><p class="no_margin">Power Doppler tenosynovitis sum score</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="chi1.tab11_5"><p class="no_margin">If the 95% CI did not cross the null line then no
|
|
serious imprecision was recorded. If the 95% CI
|
|
crossed the null line then serious imprecision was
|
|
recorded.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchi1tab12"><div id="chi1.tab12" class="table"><h3><span class="label">Table 12</span><span class="title">Cost of outpatient rheumatology appointments</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab12/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab12_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Code</th><th id="hd_h_chi1.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency
|
|
Description</th><th id="hd_h_chi1.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of attendances</th><th id="hd_h_chi1.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">National Average Unit
|
|
Cost</th></tr></thead><tbody><tr><th headers="hd_h_chi1.tab12_1_1_1_1 hd_h_chi1.tab12_1_1_1_2 hd_h_chi1.tab12_1_1_1_3 hd_h_chi1.tab12_1_1_1_4" id="hd_b_chi1.tab12_1_1_1_1" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">Consultant
|
|
led</th></tr><tr><td headers="hd_h_chi1.tab12_1_1_1_1 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">WF01A</td><td headers="hd_h_chi1.tab12_1_1_1_2 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-Admitted Face to Face
|
|
Attendance, Follow-Up</td><td headers="hd_h_chi1.tab12_1_1_1_3 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1,223,574</td><td headers="hd_h_chi1.tab12_1_1_1_4 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£137</td></tr><tr><td headers="hd_h_chi1.tab12_1_1_1_1 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">WF01B</td><td headers="hd_h_chi1.tab12_1_1_1_2 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-Admitted Face to Face
|
|
Attendance, First</td><td headers="hd_h_chi1.tab12_1_1_1_3 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">311,626</td><td headers="hd_h_chi1.tab12_1_1_1_4 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£220</td></tr><tr><td headers="hd_h_chi1.tab12_1_1_1_1 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">WF02A</td><td headers="hd_h_chi1.tab12_1_1_1_2 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multi-professional
|
|
Non-Admitted Face to Face Attendance, Follow-Up</td><td headers="hd_h_chi1.tab12_1_1_1_3 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7,357</td><td headers="hd_h_chi1.tab12_1_1_1_4 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£218</td></tr><tr><td headers="hd_h_chi1.tab12_1_1_1_1 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">WF02B</td><td headers="hd_h_chi1.tab12_1_1_1_2 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multi-professional
|
|
Non-Admitted Face to Face Attendance, First</td><td headers="hd_h_chi1.tab12_1_1_1_3 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4,219</td><td headers="hd_h_chi1.tab12_1_1_1_4 hd_b_chi1.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£246</td></tr><tr><th headers="hd_h_chi1.tab12_1_1_1_1 hd_h_chi1.tab12_1_1_1_2 hd_h_chi1.tab12_1_1_1_3 hd_h_chi1.tab12_1_1_1_4" id="hd_b_chi1.tab12_1_1_6_1" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">Non-consultant
|
|
led</th></tr><tr><td headers="hd_h_chi1.tab12_1_1_1_1 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">WF01A</td><td headers="hd_h_chi1.tab12_1_1_1_2 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-Admitted Face to Face
|
|
Attendance, Follow-Up</td><td headers="hd_h_chi1.tab12_1_1_1_3 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">250,578</td><td headers="hd_h_chi1.tab12_1_1_1_4 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£87</td></tr><tr><td headers="hd_h_chi1.tab12_1_1_1_1 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">WF01B</td><td headers="hd_h_chi1.tab12_1_1_1_2 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-Admitted Face to Face
|
|
Attendance, First</td><td headers="hd_h_chi1.tab12_1_1_1_3 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59,478</td><td headers="hd_h_chi1.tab12_1_1_1_4 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£146</td></tr><tr><td headers="hd_h_chi1.tab12_1_1_1_1 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">WF02A</td><td headers="hd_h_chi1.tab12_1_1_1_2 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multi-professional
|
|
Non-Admitted Face to Face Attendance, Follow-Up</td><td headers="hd_h_chi1.tab12_1_1_1_3 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">928</td><td headers="hd_h_chi1.tab12_1_1_1_4 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£106</td></tr><tr><td headers="hd_h_chi1.tab12_1_1_1_1 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">WF02B</td><td headers="hd_h_chi1.tab12_1_1_1_2 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multi-professional
|
|
Non-Admitted Face to Face Attendance, First</td><td headers="hd_h_chi1.tab12_1_1_1_3 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">366</td><td headers="hd_h_chi1.tab12_1_1_1_4 hd_b_chi1.tab12_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£114</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS Reference costs, 2015-2016<a class="bibr" href="#pti.ref3" rid="pti.ref3"><sup>3</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchi1tab13"><div id="chi1.tab13" class="table"><h3><span class="label">Table 13</span><span class="title">Cost of ultrasound</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/chi1.tab13/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chi1.tab13_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Department
|
|
Description<a href="/books/n/niceng100eri1/?report=reader" class="toc-item"><sup>(a)</sup></a></th><th id="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Code</th><th id="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency
|
|
Description</th><th id="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of
|
|
examinations</th><th id="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">National Average Unit
|
|
Cost</th></tr></thead><tbody><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Direct Access</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD40Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of less than 20 minutes, without
|
|
contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1,905,598</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£51</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Direct Access</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD41Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of less than 20 minutes, with contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43,644</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£39</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Direct Access</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD42Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of 20 minutes and over, without
|
|
contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">463,721</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£60</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Direct Access</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD43Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of 20 minutes and over, with contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23,462</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£52</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Direct Access</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD44Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan, Mobile or
|
|
Intraoperative Procedures, with duration of less
|
|
than 20 minutes</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31,126</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£42</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Direct Access</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD45Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan, Mobile or
|
|
Intraoperative Procedures, with duration of 20 to 40
|
|
minutes</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22,770</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£99</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outpatient</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD40Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of less than 20 minutes, without
|
|
contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1,993,859</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£55</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outpatient</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD41Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of less than 20 minutes, with contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48,731</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£52</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outpatient</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD42Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of 20 minutes and over, without
|
|
contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">519,666</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£66</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outpatient</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD43Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of 20 minutes and over, with contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20,377</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£66</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outpatient</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD44Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan, Mobile or
|
|
Intraoperative Procedures, with duration of less
|
|
than 20 minutes</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28,758</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£55</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outpatient</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD45Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan, Mobile or
|
|
Intraoperative Procedures, with duration of 20 to 40
|
|
minutes</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64,212</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£89</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD40Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of less than 20 minutes, without
|
|
contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18,468</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£56</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other</td><td headers="hd_h_chi1.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD42Z</td><td headers="hd_h_chi1.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Scan with
|
|
duration of 20 minutes and over, without
|
|
contrast</td><td headers="hd_h_chi1.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3,556</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£88</td></tr><tr><td headers="hd_h_chi1.tab13_1_1_1_1 hd_h_chi1.tab13_1_1_1_2 hd_h_chi1.tab13_1_1_1_3 hd_h_chi1.tab13_1_1_1_4" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Weighted
|
|
average</b>
|
|
</td><td headers="hd_h_chi1.tab13_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>£55</b>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS Reference costs, 2015-2016<a class="bibr" href="#pti.ref3" rid="pti.ref3"><sup>3</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="chi1.tab13_1"><p class="no_margin">Direct access services are provided independently of an
|
|
admission or outpatient attendance because a patient is
|
|
referred by a GP for a test or self-refers.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobptiappbtab1"><div id="pti.appb.tab1" class="table"><h3><span class="label">Table 16</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_pti.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_pti.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_pti.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_pti.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (Ovid)</td><td headers="hd_h_pti.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 09 October
|
|
2017</td><td headers="hd_h_pti.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions</td></tr><tr><td headers="hd_h_pti.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (Ovid)</td><td headers="hd_h_pti.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 09 October
|
|
2017</td><td headers="hd_h_pti.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions</td></tr><tr><td headers="hd_h_pti.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library
|
|
(Wiley)</td><td headers="hd_h_pti.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Cochrane Reviews to
|
|
2017</p>
|
|
<p>Issue 10 of 12</p>
|
|
<p>CENTRAL to 2017
|
|
Issue 9 of 12</p>
|
|
<p>DARE, and NHSEED to
|
|
2015</p>
|
|
<p>Issue 2 of 4</p>
|
|
<p>HTA to 2016 Issue 4
|
|
of 4</p>
|
|
</td><td headers="hd_h_pti.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptiappbtab2"><div id="pti.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Arthritis,
|
|
Rheumatoid/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
|
idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
|
polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
|
|
language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical
|
|
article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
|
|
comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
|
trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 not 19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal
|
|
Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
|
|
mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20-26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Ultrasonography/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(ultrasound* or ultrason*
|
|
or echograph* or echotomograph* or
|
|
doppler).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29 or 30</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 and 31</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptiappbtab3"><div id="pti.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *rheumatoid
|
|
arthritis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
|
idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
|
polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
|
|
language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case
|
|
study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
|
|
comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
|
trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal
|
|
Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental
|
|
Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
|
|
mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *echography/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(ultrasound* or ultrason*
|
|
or echograph* or echotomograph* or
|
|
doppler).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27 or 28</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 and 29</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptiappbtab4"><div id="pti.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">[mh “Arthritis,
|
|
Rheumatoid”]</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid near/2
|
|
(arthritis or arthrosis)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* near/2
|
|
syndrome):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* near/2
|
|
syndrome):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid near/2
|
|
factor):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
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idiopathic) near/2 arthritis):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">inflammatory
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polyarthritis:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #1-#7)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">[mh Ultrasonography]</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(ultrasound* or ultrason*
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or echograph* or echotomograph* or
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doppler):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9 or #10</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8 and #11</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptiappbtab5"><div id="pti.appb.tab5" class="table"><h3><span class="label">Table 17</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_pti.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_pti.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_pti.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_pti.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_pti.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 06 October
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2017</td><td headers="hd_h_pti.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Health
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economics studies</p>
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</td></tr><tr><td headers="hd_h_pti.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_pti.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 06 October
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2017</td><td headers="hd_h_pti.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Health
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economics studies</p>
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</td></tr><tr><td headers="hd_h_pti.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and
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Dissemination (CRD)</td><td headers="hd_h_pti.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>HTA - 2001 – 06
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October 2017</p>
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<p>NHSEED - 2001 – 31 March
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2015</p>
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</td><td headers="hd_h_pti.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptiappbtab6"><div id="pti.appb.tab6" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Arthritis,
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Rheumatoid/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
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(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
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syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
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syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
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factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
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idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
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polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
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language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical
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article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
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|
comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
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trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 not 19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal
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experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
|
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mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20-26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost
|
|
Analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics,
|
|
Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics,
|
|
Medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics,
|
|
Pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and
|
|
Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or
|
|
pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or
|
|
pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or
|
|
utilit* or benefit* or minimi* or unit* or estimat*
|
|
or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or
|
|
fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or
|
|
monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/29-44</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp models, economic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Models, Theoretical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Models,
|
|
Organizational/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">markov chains/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Decision Theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte
|
|
carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or
|
|
analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/46-54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 and (45 or 55)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptiappbtab7"><div id="pti.appb.tab7" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *rheumatoid
|
|
arthritis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
|
idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
|
polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
|
|
language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case
|
|
study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
|
|
comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
|
trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal
|
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Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental
|
|
Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
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mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">statistical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic aspect/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27 and 28</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*theoretical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*nonbiological model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">stochastic model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision tree/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte
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carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or
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analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/29-38</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *economic
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evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *health care
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cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or
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pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or
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pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or
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utilit* or benefit* or minimi* or unit* or estimat*
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or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or
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fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or
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monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/40-52</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 and (39 or 53)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptiappbtab8"><div id="pti.appb.tab8" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Arthritis,
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Rheumatoid EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((rheumatoid adj2
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(arthritis or arthrosis)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((caplan* adj2
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syndrome))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((felty* adj2
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syndrome))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((rheumatoid adj2
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factor))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((inflammatory or
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idiopathic) adj2 arthritis))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(“inflammatory
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polyarthritis”)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 OR #2 OR #3 OR #4 OR #5
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OR #6 OR #7</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobptiappcfig1"><div id="pti.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20ultrasound%20monitoring.&p=BOOKS&id=577152_ptiappcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of ultrasound monitoring." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection for the review of
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ultrasound monitoring</span></h3></div></article><article data-type="fig" id="figobptiappefig2"><div id="pti.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Change%20in%20Disease%20activity%20score%20(DAS28).&p=BOOKS&id=577152_ptiappef2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef2.jpg" alt="Figure 2. Change in Disease activity score (DAS28)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Change in Disease activity score (DAS28)</span></h3></div></article><article data-type="fig" id="figobptiappefig3"><div id="pti.appe.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20Change%20in%20function%20(RAID%20score).&p=BOOKS&id=577152_ptiappef3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef3.jpg" alt="Figure 3. Change in function (RAID score)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">Change in function (RAID score)</span></h3></div></article><article data-type="fig" id="figobptiappefig4"><div id="pti.appe.fig4" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.%20Change%20in%20Quality%20of%20life%20(EQ-5D).&p=BOOKS&id=577152_ptiappef4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef4.jpg" alt="Figure 4. Change in Quality of life (EQ-5D)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 4</span><span class="title">Change in Quality of life (EQ-5D)</span></h3></div></article><article data-type="fig" id="figobptiappefig5"><div id="pti.appe.fig5" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%205.%20Remission%20(DAS%3C1.6).&p=BOOKS&id=577152_ptiappef5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef5.jpg" alt="Figure 5. Remission (DAS<1.6)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 5</span><span class="title">Remission (DAS<1.6)</span></h3></div></article><article data-type="fig" id="figobptiappefig6"><div id="pti.appe.fig6" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%206.%20Change%20in%20pain%20(VAS).&p=BOOKS&id=577152_ptiappef6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef6.jpg" alt="Figure 6. Change in pain (VAS)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 6</span><span class="title">Change in pain (VAS)</span></h3></div></article><article data-type="fig" id="figobptiappefig7"><div id="pti.appe.fig7" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%207.%20Withdrawal%20from%20trial%20due%20to%20%0201Cno%20longer%20willing%0201D.&p=BOOKS&id=577152_ptiappef7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef7.jpg" alt="Figure 7. Withdrawal from trial due to “no longer willing”." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 7</span><span class="title">Withdrawal from trial due to “no longer
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willing”</span></h3></div></article><article data-type="fig" id="figobptiappefig8"><div id="pti.appe.fig8" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%208.%20Withdrawal%20from%20trial%20due%20to%20adverse%20events.&p=BOOKS&id=577152_ptiappef8.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef8.jpg" alt="Figure 8. Withdrawal from trial due to adverse events." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 8</span><span class="title">Withdrawal from trial due to adverse events</span></h3></div></article><article data-type="fig" id="figobptiappefig9"><div id="pti.appe.fig9" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%209.%20Clinical%20and%20US%20prognostic%20factors%20for%20MRI%20erosive%20progression%20(dichotomous%3B%20at%201%20year).&p=BOOKS&id=577152_ptiappef9.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef9.jpg" alt="Figure 9. Clinical and US prognostic factors for MRI erosive progression (dichotomous; at 1 year)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 9</span><span class="title">Clinical and US prognostic factors for MRI erosive
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progression (dichotomous; at 1 year)</span></h3></div></article><article data-type="fig" id="figobptiappefig10"><div id="pti.appe.fig10" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2010.%20Clinical%20and%20US%20prognostic%20factors%20for%20disease%20flare%20(increase%20in%20disease%20activity%20requiring%20an%20initiation%2C%20change%20or%20increase%20in%20therapy%20based%20on%20DAS28%3B%20dichotomous%20%02013%20at%201%20year).&p=BOOKS&id=577152_ptiappef10.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef10.jpg" alt="Figure 10. Clinical and US prognostic factors for disease flare (increase in disease activity requiring an initiation, change or increase in therapy based on DAS28; dichotomous – at 1 year)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 10</span><span class="title">Clinical and US prognostic factors for disease flare
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(increase in disease activity requiring an initiation,
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change or increase in therapy based on DAS28; dichotomous
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– at 1 year)</span></h3></div></article><article data-type="fig" id="figobptiappefig11"><div id="pti.appe.fig11" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2011.%20Clinical%20and%20US%20prognostic%20factors%20for%20relapse%20(DAS28-ESR%3E2.6%20following%20a%20period%20of%20clinical%20remission%3B%20dichotomous%20%02013%20at%201%20year).&p=BOOKS&id=577152_ptiappef11.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef11.jpg" alt="Figure 11. Clinical and US prognostic factors for relapse (DAS28-ESR>2.6 following a period of clinical remission; dichotomous – at 1 year)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 11</span><span class="title">Clinical and US prognostic factors for relapse
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(DAS28-ESR>2.6 following a period of clinical
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remission; dichotomous – at 1 year)</span></h3><div class="caption"><p>Note: DAS28-ESR was independently associated with the outcome
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but data is not presented here as it was incorrectly
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reported by the authors.</p></div></div></article><article data-type="fig" id="figobptiappefig12"><div id="pti.appe.fig12" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2012.%20Clinical%20and%20US%20prognostic%20factors%20for%20remission%20(DAS28-CRP4v%20%3C2.6%3B%20dichotomous%20%02013%20at1%20year).&p=BOOKS&id=577152_ptiappef12.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef12.jpg" alt="Figure 12. Clinical and US prognostic factors for remission (DAS28-CRP4v <2.6; dichotomous – at1 year)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 12</span><span class="title">Clinical and US prognostic factors for remission
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(DAS28-CRP4v <2.6; dichotomous – at1
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year)</span></h3></div></article><article data-type="fig" id="figobptiappefig13"><div id="pti.appe.fig13" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2013.%20Clinical%20and%20US%20prognostic%20factors%20for%20remission%20(DAS44-CRP4v%20%3C1.6%3B%20dichotomous%20%02013%20at1%20year).&p=BOOKS&id=577152_ptiappef13.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappef13.jpg" alt="Figure 13. Clinical and US prognostic factors for remission (DAS44-CRP4v <1.6; dichotomous – at1 year)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 13</span><span class="title">Clinical and US prognostic factors for remission
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(DAS44-CRP4v <1.6; dichotomous – at1
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year)</span></h3></div></article><article data-type="fig" id="figobptiappgfig14"><div id="pti.appg.fig14" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2014.%20Flow%20chart%20of%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=577152_ptiappgf14.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577152/bin/ptiappgf14.jpg" alt="Figure 14. Flow chart of economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 14</span><span class="title">Flow chart of economic study selection for the
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guideline</span></h3><div class="caption"><p>* Non-relevant population, intervention, comparison, design or
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setting; non-English language</p></div></div></article><article data-type="table-wrap" id="figobptiappitab1"><div id="pti.appi.tab1" class="table"><h3><span class="label">Table 25</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Aydin 2017<a class="bibr" href="#pti.ref1" rid="pti.ref1"><sup>1</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unobtainable</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Backhaus 2013<a class="bibr" href="#pti.ref2" rid="pti.ref2"><sup>2</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
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confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bellis 2016<a class="bibr" href="#pti.ref4" rid="pti.ref4"><sup>4</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cross-sectional study, no
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follow-up</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brown 2008<a class="bibr" href="#pti.ref6" rid="pti.ref6"><sup>6</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
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|
confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bugatti 2016<a class="bibr" href="#pti.ref7" rid="pti.ref7"><sup>7</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no relevant outcomes</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bugatti 2012<a class="bibr" href="#pti.ref8" rid="pti.ref8"><sup>8</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
all key confounders; outcome is indirect</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bugatti 2012<a class="bibr" href="#pti.ref50" rid="pti.ref50"><sup>50</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">see above</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cavet 2009<a class="bibr" href="#pti.ref9" rid="pti.ref9"><sup>9</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear if analyses are
|
|
adjusted for confounders; incomplete reporting of
|
|
results</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chen 2017<a class="bibr" href="#pti.ref10" rid="pti.ref10"><sup>10</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
key confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cheung 2016<a class="bibr" href="#pti.ref12" rid="pti.ref12"><sup>12</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Key confounders for the
|
|
outcome (radiographic progression) not considered in
|
|
analysis</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cheung 2014<a class="bibr" href="#pti.ref11" rid="pti.ref11"><sup>11</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression analysis; no
|
|
anti-CCP measured</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Christensen 2016<a class="bibr" href="#pti.ref13" rid="pti.ref13"><sup>13</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study duration only 4
|
|
months</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">D’Agostino
|
|
2016<a class="bibr" href="#pti.ref14" rid="pti.ref14"><sup>14</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">D’Agostino
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|
2017<a class="bibr" href="#pti.ref15" rid="pti.ref15"><sup>15</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">narrative review</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dale 2016<a class="bibr" href="#pti.ref17" rid="pti.ref17"><sup>17</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">mixed study population of
|
|
RA and UA (breakdown unknown)</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dale 2014<a class="bibr" href="#pti.ref16" rid="pti.ref16"><sup>16</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">mixed study population of
|
|
RA and UA (breakdown unknown)</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dougados 2012<a class="bibr" href="#pti.ref18" rid="pti.ref18"><sup>18</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression analysis; no
|
|
anti-CCP measured</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dougados 2013<a class="bibr" href="#pti.ref19" rid="pti.ref19"><sup>19</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression analysis; no
|
|
anti-CCP measured</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">El Miedany 2016<a class="bibr" href="#pti.ref20" rid="pti.ref20"><sup>20</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">results incompletely
|
|
reported</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fukae 2017<a class="bibr" href="#pti.ref21" rid="pti.ref21"><sup>21</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
key confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gartner 2015<a class="bibr" href="#pti.ref22" rid="pti.ref22"><sup>22</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">analyses not adjusted for
|
|
confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hammer 2017<a class="bibr" href="#pti.ref27" rid="pti.ref27"><sup>27</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression
|
|
analysis</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Han 2016<a class="bibr" href="#pti.ref28" rid="pti.ref28"><sup>28</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">systematic review</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Harman 2015<a class="bibr" href="#pti.ref30" rid="pti.ref30"><sup>30</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Harman 2015<a class="bibr" href="#pti.ref29" rid="pti.ref29"><sup>29</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">multivariate analysis
|
|
model does not include factors of interest</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hirata 2017<a class="bibr" href="#pti.ref31" rid="pti.ref31"><sup>31</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study
|
|
design</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Horton 2017<a class="bibr" href="#pti.ref33" rid="pti.ref33"><sup>33</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hurnakova 2015<a class="bibr" href="#pti.ref35" rid="pti.ref35"><sup>35</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cross-sectional study</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hurnakova 2016<a class="bibr" href="#pti.ref34" rid="pti.ref34"><sup>34</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study
|
|
design</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Iagnocco 2015<a class="bibr" href="#pti.ref36" rid="pti.ref36"><sup>36</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
key confounders; outcomes incompletely reported</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ikeda 2007<a class="bibr" href="#pti.ref37" rid="pti.ref37"><sup>37</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ikeda 2013<a class="bibr" href="#pti.ref39" rid="pti.ref39"><sup>39</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study looked at ultrasound
|
|
alone not in combination with clinical
|
|
assessment</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ikeda 2012<a class="bibr" href="#pti.ref38" rid="pti.ref38"><sup>38</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">see above</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ivanac 2015<a class="bibr" href="#pti.ref40" rid="pti.ref40"><sup>40</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study looked at ultrasound
|
|
alone not in combination with clinical
|
|
assessment</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Janta 2016<a class="bibr" href="#pti.ref41" rid="pti.ref41"><sup>41</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
key confounders; results incomplete</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jeka 2017<a class="bibr" href="#pti.ref42" rid="pti.ref42"><sup>42</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression
|
|
analysis</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jindal 2017<a class="bibr" href="#pti.ref43" rid="pti.ref43"><sup>43</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unobtainable</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kakavouli 2015<a class="bibr" href="#pti.ref44" rid="pti.ref44"><sup>44</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single case study</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kamel 2017<a class="bibr" href="#pti.ref45" rid="pti.ref45"><sup>45</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kawashiri 2017<a class="bibr" href="#pti.ref46" rid="pti.ref46"><sup>46</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">retrospective study</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kirino 2015<a class="bibr" href="#pti.ref47" rid="pti.ref47"><sup>47</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">retrospective study</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Komarova 2015<a class="bibr" href="#pti.ref48" rid="pti.ref48"><sup>48</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study
|
|
design</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Luz 2016<a class="bibr" href="#pti.ref49" rid="pti.ref49"><sup>49</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
key confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Manzo 2012<a class="bibr" href="#pti.ref50" rid="pti.ref50"><sup>50</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">shouldn’t have been
|
|
ordered - exclude from EXCLUSION TABLE</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naredo 2007<a class="bibr" href="#pti.ref51" rid="pti.ref51"><sup>51</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naredo 2008<a class="bibr" href="#pti.ref52" rid="pti.ref52"><sup>52</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no anti-CCP and no
|
|
baseline erosions measured</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Osipyants 2013<a class="bibr" href="#pti.ref54" rid="pti.ref54"><sup>54</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not enough information on
|
|
analyses (conference abstract)</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Osipyants 2013<a class="bibr" href="#pti.ref55" rid="pti.ref55"><sup>55</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not enough information on
|
|
analyses (conference abstract)</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ramírez
|
|
García 2014<a class="bibr" href="#pti.ref56" rid="pti.ref56"><sup>56</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjustment for confounders
|
|
unclear; incomplete reporting of results</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rees 2007<a class="bibr" href="#pti.ref57" rid="pti.ref57"><sup>57</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression
|
|
analysis</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reynolds 2009<a class="bibr" href="#pti.ref58" rid="pti.ref58"><sup>58</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression
|
|
analysis</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rosa 2016<a class="bibr" href="#pti.ref59" rid="pti.ref59"><sup>59</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cross-sectional study;
|
|
analyses not adjusted for key confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Scire 2009<a class="bibr" href="#pti.ref61" rid="pti.ref61"><sup>61</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">mixed patient population
|
|
(either RA or undifferentiated polyarthritis)</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sreerangaiah 2016<a class="bibr" href="#pti.ref62" rid="pti.ref62"><sup>62</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">results incompletely
|
|
presented; unclear if analyses was adjusted for key
|
|
confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Takase-Minegishi 2017<a class="bibr" href="#pti.ref63" rid="pti.ref63"><sup>63</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review:
|
|
references checked</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tan 2016<a class="bibr" href="#pti.ref64" rid="pti.ref64"><sup>64</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression
|
|
analysis</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Taylor 2004<a class="bibr" href="#pti.ref65" rid="pti.ref65"><sup>65</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear if analyses are
|
|
adjusted for confounders; incomplete reporting of
|
|
results</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tokai 2015<a class="bibr" href="#pti.ref66" rid="pti.ref66"><sup>66</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
key confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Toyota 2016<a class="bibr" href="#pti.ref67" rid="pti.ref67"><sup>67</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unobtainable</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Valor 2016<a class="bibr" href="#pti.ref68" rid="pti.ref68"><sup>68</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study
|
|
design</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Van der ven 2017<a class="bibr" href="#pti.ref69" rid="pti.ref69"><sup>69</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vlad 2015<a class="bibr" href="#pti.ref70" rid="pti.ref70"><sup>70</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
key confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vreju 2016<a class="bibr" href="#pti.ref71" rid="pti.ref71"><sup>71</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Key confounders for the
|
|
outcome not considered in analysis</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wakefield 2007<a class="bibr" href="#pti.ref72" rid="pti.ref72"><sup>72</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analyses not adjusted for
|
|
confounders</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yamada 2016<a class="bibr" href="#pti.ref73" rid="pti.ref73"><sup>73</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unobtainable</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yoshimi 2013<a class="bibr" href="#pti.ref75" rid="pti.ref75"><sup>75</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression analysis; no
|
|
anti-CCP measured</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yoshimi 2014<a class="bibr" href="#pti.ref74" rid="pti.ref74"><sup>74</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no regression analysis; no
|
|
anti-CCP measured</td></tr><tr><td headers="hd_h_pti.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zhao 2017<a class="bibr" href="#pti.ref77" rid="pti.ref77"><sup>77</sup></a></td><td headers="hd_h_pti.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Literature review</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptiappitab2"><div id="pti.appi.tab2" class="table"><h3><span class="label">Table 26</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appi.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appi.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_pti.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_pti.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_pti.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_pti.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptiappjtab1"><div id="pti.appj.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577152/table/pti.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__pti.appj.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_pti.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO question</th><td headers="hd_b_pti.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Population: Adults
|
|
with RA in whom clinical examination is
|
|
inconclusive or is inconsistent with other signs
|
|
of disease activity</p>
|
|
<p>Intervention(s):
|
|
Treatment adjusted throughultrasound assessment
|
|
plus usual monitoring
|
|
assessments</p>
|
|
<p>Comparison: Treatment adjusted
|
|
through standard monitoring assessments
|
|
alone</p>
|
|
<p>Outcome(s): Disease activity, numbers
|
|
in remission, numbers with low disease activity,
|
|
quality of life, function and pain, radiographic
|
|
progression</p>
|
|
</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance to patients
|
|
or the population</th><td headers="hd_b_pti.appj.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">If ultrasound can be
|
|
used to provide healthcare professionals with
|
|
additional information on disease activity when
|
|
standard monitoring assessments are inconclusive,
|
|
this would enable more informed management
|
|
decisions to be made. By enabling accurate
|
|
assessment, ultrasound may facilitate appropriate
|
|
treatment adjustment to achieve the agreed target
|
|
and improve prognosis. People with RA may
|
|
therefore have improvements in clinical status,
|
|
symptoms and quality of life and avoid receiving
|
|
inappropriate therapies. Ultrasound is a very
|
|
simple non-invasive investigation, which is valued
|
|
by people with RA as it enables them to visualise
|
|
their disease activity. This in itself may also
|
|
improve outcomes, by encouraging medication
|
|
adherence and facilitating agreement to treatment
|
|
escalation where necessary.</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to NICE
|
|
guidance</th><td headers="hd_b_pti.appj.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current NICE guidance
|
|
recommends against using US for routine monitoring
|
|
of disease activity. This research would aim to
|
|
identify whether there is an important subset of
|
|
people with RA who would benefit.</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to the
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NHS</th><td headers="hd_b_pti.appj.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>If ultrasound was
|
|
found to be clinically and cost effective in
|
|
assessing disease activity in certain subgroups of
|
|
people with RA, its use may increase in those
|
|
groups of people.</p>
|
|
<p>Although there may be
|
|
additional training requirements for
|
|
rheumatologists or other members of the MDT and
|
|
upfront costs to supply the equipment, if the use
|
|
of ultrasound for monitoring is found to enable a
|
|
more appropriate management strategy, this may be
|
|
cost neutral or even cost saving through better
|
|
management of RA.</p>
|
|
</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">National
|
|
priorities</th><td headers="hd_b_pti.appj.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence
|
|
base</th><td headers="hd_b_pti.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Randomised
|
|
controlled evidence in the evidence review
|
|
reported in chapter I showed no benefit of
|
|
ultrasound to routine monitoring of disease
|
|
activity in people with RA. Evidence looking at
|
|
the association between ultrasound findings and
|
|
subsequent poor outcomes were of generally low to
|
|
very low quality and their findings were
|
|
inconsistent and inconclusive and insufficient to
|
|
inform a recommendation. Therefore a
|
|
recommendation was made against the use of
|
|
ultrasound for routine monitoring for all people
|
|
with RA.</p>
|
|
<p>No RCTs were available in the
|
|
particular subgroups identified in this research
|
|
question – namely people with RA in whom
|
|
clinical examination is inconclusive or is
|
|
inconsistent with other signs of disease
|
|
activity.</p>
|
|
</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Equality</th><td headers="hd_b_pti.appj.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound may be of
|
|
benefit where synovitis is difficult to assess in
|
|
case of obesity or extensive deformities.</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_pti.appj.tab1_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Randomised
|
|
controlled trial comparing treatment adjusted
|
|
through clinical assessment plus ultrasound, with
|
|
treatment adjusted through clinical assessment
|
|
alone. Inclusion criteria would be people with RA
|
|
in whom clinical examination is inconclusive or is
|
|
inconsistent with other signs of disease activity,
|
|
as described above.</p>
|
|
<p>This could be cluster
|
|
randomised to aid feasibility by increasing
|
|
recruitment potential.</p>
|
|
<p>Trial duration: at
|
|
least 1 year</p>
|
|
</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Feasibility</th><td headers="hd_b_pti.appj.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The main issue would
|
|
be to ensure cross-site agreement on US scoring
|
|
and technique, and therefore this should be
|
|
considered and pre-specified in the trial
|
|
protocol.</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other comments</th><td headers="hd_b_pti.appj.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>This is an
|
|
important question appropriate for funding from
|
|
several potential sources.</p>
|
|
<p>Ultrasound is
|
|
currently being used in an ad hoc way with
|
|
substantial variation in practice around the
|
|
country. If it is shown to be of added value in
|
|
particular subgroups of patients, it has the
|
|
potential to improve the application of the
|
|
current treat to target strategy in a focussed
|
|
way.</p>
|
|
</td></tr><tr><th id="hd_b_pti.appj.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance</th><td headers="hd_b_pti.appj.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l227"><li id="lt692" class="half_rhythm"><div>High: the research is essential to inform
|
|
future updates of key recommendations in the
|
|
guideline.</div></li></ul>
|
|
</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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