Advanced imaging in the evaluation of lupus arthritis: A systematic literature review and meta-analysis

Introduction: Joint involvement is present in up to 95 % of patients with SLE. Arthritis is a main cause of work- related disability and 70-80 % of lupus patients in clinical trials have active joint manifestations. Objective: To review the evidence on the application of musculoskeletal (MSK) ultrasound (US), magnetic resonance imaging (MRI), and optical imaging (OI) in patients with SLE hand and wrist arthritis, discuss measurement properties of US, MRI, and OI, and to provide combined results from these studies. Methods: For this systematic review, three separate population, intervention, comparator, and outcome structured (PICOS) literature searches were conducted for US, MRI and OI using PubMed, EMBASE and the Cochrane Library. The search for US was restricted for the period Jan 1, 2019, to March 31, 2024. Results: Of the 502 identified articles for MSK US, 16 were included. Of the 2101 identified articles for MRI, only 8 were included. Of the 20 identified articles for OI, 1 was included. Data on the use of MSK US, MRI, and OI were evaluated separately regarding reported imaging abnormalities, the definition and scoring of these abnormalities, and measurement properties. Pooled analysis showed strong association between arthritis/arthralgia and US synovitis (10.89 [4.02, 29.48]) and tenosynovitis (5.93 [1.99, 17.72]); association between joint symptoms and US synovitis decreased to 5.00 (1.11, 22.60) when restricted to physician confirmed arthritis. Conclusion: The current systematic literature review examined available information on the use of advanced imaging modalities in the evaluation of hand and wrist involvement in SLE. This literature review demonstrates the need for further research to substantiate the use of advanced imaging as an outcome measure for the MSK manifestations in patients with SLE.