Are Routine X-Rays of Hands and Feet Worthwhile in Patients with Suspected Rheumatoid Arthritis?

Primary care clinicians and rheumatologists often obtain x-rays of hands and feet in patients with suspected rheumatoid arthritis (RA); the rationale is that finding erosions typical for RA will be useful diagnostically and prognostically. In a retrospective study, Dutch researchers examined the yield of this practice among 724 new patients evaluated for suspected RA at a university rheumatology clinic; all patients had routine x-rays of hands and feet. Median symptom duration was 6 months at the initial visit.

RA eventually was diagnosed in 41% of the 724 patients. Only 32 patients — 4% of the overall cohort — had erosions typical for RA on initial presentation. The prevalence of erosions was lower in seronegative patients and in patients w…