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The use of plain radiography in diagnosing osteoarthritis: A systematic review and time trend analysis

Henry-Blake, Connor; Marshall, Michelle; Treadwell, Kane; Parmar, Simran; Higgs, Jordan; Edwards, John J.; Peat, George

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Connor Henry-Blake

Kane Treadwell

Simran Parmar

Jordan Higgs

John J. Edwards

George Peat


The National Institute for Health and Care Excellence (NICE) suggest there is no role for routine radiography in the diagnosis of osteoarthritis (OA). It is not known how consistent this recommendation is across international guidelines, or the impact of UK guidance on domestic OA X-ray request rates.

A systematic search identified guideline recommendations on the role of radiography in OA diagnosis. Full texts underwent dual screening and appraisal using the AGREE II tool. A narrative synthesis was performed. Consultation data were extracted from a UK primary care database: the Consultations in Primary Care Archives (CiPCA). The annual proportion of X-ray requests per 100 OA consulters from 2000 to 2012 were calculated. Joinpoint regression analysis examined if there were changes in the trend of X-ray request rates and compared these with the publication dates of UK guidelines.

Eighteen evidence-based OA guidelines were included in the review. Eleven recommended a clinical diagnosis of OA without radiographic confirmation. Seven recommended routine radiography; these guidelines were predominantly for radiologists. A mean of 17.3 X-rays per 100 patients were requested in patients consulting for OA per year between 2000 and 2012. A statistically significant reduction in X-ray request rates was seen in 2003.

Recommendations on the role of radiography in OA vary between medical specialty and countries. UK guidelines appear to have had a limited impact on X-ray request rates in OA.

Journal Article Type Article
Acceptance Date Nov 17, 2022
Online Publication Date Nov 25, 2022
Publication Date 2022
Journal Musculoskeletal Care
Print ISSN 1478-2189
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 21
Issue 2
Pages 462-477
Keywords guideline; osteoarthritis; radiography; rate; systematic review; trend; X-ray
Publisher URL


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