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DOI: 10.1055/s-0045-1802953
Role of Imaging in Nondegenerative Arthritis in Low- and Middle-Income Countries

Abstract
Arthritis is an important cause of disability globally, with high prevalence in low- and middle-income countries. Although osteoarthritis is the most common type of arthritis, various types of nondegenerative arthritis are prevalent in low- and middle-income countries. Multiple imaging modalities, such as radiography, ultrasound, computed tomography, and magnetic resonance imaging, are helpful in diagnosing and prognosticating arthritis. Although imaging appearances can overlap between types of arthritis, specific imaging findings have been described for the different etiologies. Knowing these imaging findings, especially on radiographs and ultrasound in resource-constrained areas, can be helpful in managing arthritis effectively.
Publication History
Article published online:
31 March 2025
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References
- 1 James SL, Abate D, Abate KH. et al; GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392 (10159): 1789-1858
- 2 Hoy D, Geere JA, Davatchi F, Meggitt B, Barrero LH. A time for action: opportunities for preventing the growing burden and disability from musculoskeletal conditions in low- and middle-income countries. Best Pract Res Clin Rheumatol 2014; 28 (03) 377-393
- 3 Storheim K, Zwart JA. Musculoskeletal disorders and the Global Burden of Disease study. Ann Rheum Dis 2014; 73 (06) 949-950
- 4 Adebayo EF, Uthman OA, Wiysonge CS, Stern EA, Lamont KT, Ataguba JE. A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries. BMC Health Serv Res 2015; 15 (01) 543
- 5 Jacobson JA, Girish G, Jiang Y, Resnick D. Radiographic evaluation of arthritis: inflammatory conditions. Radiology 2008; 248 (02) 378-389
- 6 Brower AC, Flemming DJ. Arthritis in Black and White. Philadelphia, PA: Elsevier Saunders; 2012
- 7 Black RJ, Cross M, Haile LM. et al; GBD 2021 Rheumatoid Arthritis Collaborators. Global, regional, and national burden of rheumatoid arthritis, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023; 5 (10) e594-e610
- 8 Sokka T, Kautiainen H, Pincus T. et al. Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database. Ann Rheum Dis 2009; 68 (11) 1666-1672
- 9 Keenan RT, Swearingen CJ, Yazici Y. Erythrocyte sedimentation rate and C-reactive protein levels are poorly correlated with clinical measures of disease activity in rheumatoid arthritis, systemic lupus erythematosus and osteoarthritis patients. Clin Exp Rheumatol 2008; 26 (05) 814-819
- 10 Colebatch AN, Edwards CJ, Østergaard M. et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 2013; 72 (06) 804-814
- 11 Ezzati F, Pezeshk P. Radiographic findings of inflammatory arthritis and mimics in the hands. Diagnostics (Basel) 2022; 12 (09) 2134
- 12 Ulijn E, den Broeder N, Ten Cate D. et al. Limited diagnostic and prognostic value of routine radiographs in newly presenting arthritis suspected of rheumatoid arthritis: a retrospective study. Arthritis Care Res (Hoboken) 2024; 76 (04) 497-502
- 13 Ally MMTM, Meyer PWA, Anderson R. Early rheumatoid arthritis: focus on RA in the developing world. S Afr Fam Pract 2016; 58 (04) 164-166
- 14 Shiraishi M, Fukuda T, Igarashi T, Tokashiki T, Kayama R, Ojiri H. Differentiating rheumatoid and psoriatic arthritis of the hand: multimodality imaging characteristics. Radiographics 2020; 40 (05) 1339-1354
- 15 Vyas S, Bhalla AS, Ranjan P, Kumar S, Kumar U, Gupta AK. Rheumatoid arthritis revisited - advanced imaging review. Pol J Radiol 2016; 81: 629-635
- 16 Šenolt L, Grassi W, Szodoray P. Laboratory biomarkers or imaging in the diagnostics of rheumatoid arthritis?. BMC Med 2014; 12 (01) 49
- 17 Sommer OJ, Kladosek A, Weiler V, Czembirek H, Boeck M, Stiskal M. Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics 2005; 25 (02) 381-398
- 18 Mota HLM, Laurindo IMM, dos Santos Neto LL. Imaging diagnosis of early rheumatoid arthritis. Clin Exp Rheumatol 2008; 26 (05) 814-819
- 19 Wakefield RJ, Balint PV, Szkudlarek M. et al; OMERACT 7 Special Interest Group. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32 (12) 2485-2487
- 20 Suh JY, Park SY, Koh SH, Lee IJ, Lee K. Unusual, but important, peri- and extra-articular manifestations of rheumatoid arthritis: a pictorial essay. Ultrasonography 2021; 40 (04) 602-616
- 21 Kgoebane K, Ally MMTM, Duim-Beytell MC, Suleman FE. The role of imaging in rheumatoid arthritis. SA J Radiol 2018; 22 (01) 1316
- 22 Hilabi BS, Alghamdi SA, Almanaa M. Impact of magnetic resonance imaging on healthcare in low- and middle-income countries. Cureus 2023; 15 (04) e37698
- 23 Anazodo UC, Ng JJ, Ehiogu B. et al. A framework for advancing sustainable magnetic resonance imaging access in Africa. NMR Biomed 2023; 36 (03) e4846
- 24 Narváez JA, Narváez J, De Lama E, De Albert M. MR imaging of early rheumatoid arthritis. Radiographics 2010; 30 (01) 143-163 ; discussion 163–165
- 25 McGonagle D, Conaghan PG, O'Connor P. et al. The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study. Arthritis Rheum 1999; 42 (08) 1706-1711
- 26 Martín Noguerol T, Luna A, Gómez Cabrera M, Riofrio AD. Clinical applications of advanced magnetic resonance imaging techniques for arthritis evaluation. World J Orthop 2017; 8 (09) 660-673
- 27 Østergaard M, Ejbjerg B. Magnetic resonance imaging of the synovium in rheumatoid arthritis. Semin Musculoskelet Radiol 2004; 8 (04) 287-299
- 28 Narváez JA, Narváez J, Roca Y, Aguilera C. MR imaging assessment of clinical problems in rheumatoid arthritis. Eur Radiol 2002; 12 (07) 1819-1828
- 29 Lynn MM, Mathews CJ. Advances in the management of bacterial septic arthritis. Int J Clin Rheumatol 2012; 7: 335-342
- 30 Lavy CBD. Septic arthritis in Western and sub-Saharan African children - a review. Int Orthop 2007; 31 (02) 137-144
- 31 Ikpeme I, Ngim N, Ikpeme A, Oku A. Septic arthritis: a need to strengthen the referral chain in a developing economy. Open J Orthop 2013; 3 (02) 110-118
- 32 García-Arias M, Pérez-Esteban S, Castañeda S. Septic arthritis and tuberculosis arthritis. J Arthritis 2012; 1 (01) 102
- 33 World Health Organization. Global tuberculosis report 2024. Available at: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024 . Accessed January 26, 2025
- 34 De Backer AI, Vanhoenacker FM, Sanghvi DA. Imaging features of extraaxial musculoskeletal tuberculosis. Indian J Radiol Imaging 2009; 19 (03) 176-186
- 35 Smith JW, Chalupa P, Shabaz Hasan M. Infectious arthritis: clinical features, laboratory findings and treatment. Clin Microbiol Infect 2006; 12 (04) 309-314
- 36 Shaw BA, Kasser JR. Acute septic arthritis in infancy and childhood. Clin Orthop Relat Res 1990; (257) 212-225
- 37 De Vuyst D, Vanhoenacker F, Gielen J, Bernaerts A, De Schepper AM. Imaging features of musculoskeletal tuberculosis. Eur Radiol 2003; 13 (08) 1809-1819
- 38 Yao DC, Sartoris DJ. Musculoskeletal tuberculosis. Radiol Clin North Am 1995; 33 (04) 679-689
- 39 Montgomery NI, Epps HR. Pediatric septic arthritis. Orthop Clin North Am 2017; 48 (02) 209-216
- 40 Hong SH, Kim SM, Ahn JM, Chung HW, Shin MJ, Kang HS. Tuberculous versus pyogenic arthritis: MR imaging evaluation. Radiology 2001; 218 (03) 848-853
- 41 Suh JS, Lee JD, Cho JH, Kim MJ, Han DY, Cho NH. MR imaging of tuberculous arthritis: clinical and experimental studies. J Magn Reson Imaging 1996; 6 (01) 185-189
- 42 Gamaletsou MN, Rammaert B, Brause B. et al; International Consortium for Osteoarticular Mycoses. Osteoarticular mycoses. Clin Microbiol Rev 2022; 35 (04) e0008619
- 43 Bariteau JT, Waryasz GR, McDonnell M, Fischer SA, Hayda RA, Born CT. Fungal osteomyelitis and septic arthritis. J Am Acad Orthop Surg 2014; 22 (06) 390-401
- 44 Akuri MC, Bencardino JT, Peixoto JB. et al. Fungal musculoskeletal infections: comprehensive approach to proper diagnosis. Radiographics 2024; 44 (07) e230176
- 45 Lembke S, Macfarlane GJ, Jones GT. The worldwide prevalence of psoriatic arthritis-a systematic review and meta-analysis. Rheumatology (Oxford) 2024; 63 (12) 3211-3220
- 46 Bedaiwi M, Al-Homood IA, El-Garf A. et al. Disease burden and treatment challenges of psoriatic arthritis in Africa and the Middle East. Rheumatol Int 2019; 39 (08) 1321-1329
- 47 Sudoł-Szopińska I, Matuszewska G, Kwiatkowska B, Pracoń G. Diagnostic imaging of psoriatic arthritis. Part I: etiopathogenesis, classifications and radiographic features. J Ultrason 2016; 16 (64) 65-77
- 48 Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis 2015; 74 (06) 1045-1050
- 49 Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol 2020; 16 (07) 380-390
- 50 Jatuworapruk K. Gout prevalence is rising in low-income and middle-income countries: are we ready?. Lancet Rheumatol 2024; 6 (08) e494-e495
- 51 Agudelo CA, Wise CM. Gout: diagnosis, pathogenesis, and clinical manifestations. Curr Opin Rheumatol 2001; 13 (03) 234-239
- 52 Llauger J, Palmer J, Rosón N, Bagué S, Camins A, Cremades R. Nonseptic monoarthritis: imaging features with clinical and histopathologic correlation. Radiographics 2000; 20 (Spec No): S263-S278
- 53 Jacques T, Michelin P, Badr S. et al. Conventional radiology in crystal arthritis: gout, calcium pyrophosphate deposition, and basic calcium phosphate crystals. Radiol Clin North Am 2017; 55 (05) 967-984
- 54 Girish G, Glazebrook KN, Jacobson JA. Advanced imaging in gout. AJR Am J Roentgenol 2013; 201 (03) 515-525
- 55 Chen CKH, Yeh LR, Pan HB. et al. Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients. Skeletal Radiol 1999; 28 (02) 75-80
- 56 Resnick D, Utsinger PD. The wrist arthropathy of “pseudogout” occurring with and without chondrocalcinosis. Radiology 1974; 113 (03) 633-641
- 57 Reijnierse M, Schwabl C, Klauser A. Imaging of crystal disorders: calcium pyrophosphate dihydrate crystal deposition disease, calcium hydroxyapatite crystal deposition disease and gout pathophysiology, imaging, and diagnosis. Radiol Clin North Am 2022; 60 (04) 641-656
- 58 Filippou G, Sirotti S, Cipolletta E, Filippucci E. Optimizing the use of ultrasound in calcium pyrophosphate deposition (CPPD): a review from the ground up. Gout, Urate, and Crystal Deposition Disease 2024; 2 (01) 17-33
- 59 Halverson PB, Carrera GF, McCarty DJ. Milwaukee shoulder syndrome. Fifteen additional cases and a description of contributing factors. Arch Intern Med 1990; 150 (03) 677-682
- 60 Petrova NL. The Charcot foot revisited: how the new pathogenetic findings explain the clinical course of the disease. In: Piaggesi A, Apelqvist J. eds. Frontiers in Diabetes. Vol 26. Basel, Switzerland: S. Karger AG; 2018: 48-59
- 61 Rosskopf AB, Loupatatzis C, Pfirrmann CWA, Böni T, Berli MC. The Charcot foot: a pictorial review. Insights Imaging 2019; 10 (01) 77
- 62 Frykberg RG, Belczyk R. Epidemiology of the Charcot foot. Clin Podiatr Med Surg 2008; 25 (01) 17-28 , v
- 63 Boudjenah N. Diabetic foot in Algeria. Int J Endocrinol Metab Disord 2020;6(01):
- 64 Balooch Hasankhani M, Mirzaei H, Karamoozian A. Global trend analysis of diabetes mellitus incidence, mortality, and mortality-to-incidence ratio from 1990 to 2019. Sci Rep 2023; 13 (01) 21908
- 65 Yang J, Li X, Sun Y. et al. Global epidemiology of leprosy from 2010 to 2020: a systematic review and meta-analysis of the proportion of sex, type, grade 2 deformity and age. Pathog Glob Health 2022; 116 (08) 467-476
- 66 Kress GT, Swerdlow M, Shin L. Lepromatous leprosy and Charcot neuroarthropathy of insensate feet: a case report. Cureus 2024; 16 (05) e61362
- 67 Matcuk Jr GR, Katal S, Gholamrezanezhad A. et al. Imaging of lower extremity infections: predisposing conditions, atypical infections, mimics, and differentiating features. Skeletal Radiol 2024; 53 (10) 2099-2120
- 68 Gill GV, Hayat H, Majid S. Diagnostic delays in diabetic Charcot arthropathy. Pract Diabetes Int 2004; 21 (07) 261-262
- 69 Rosenbaum AJ, DiPreta JA. Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clin Orthop Relat Res 2015; 473 (03) 1168-1171
- 70 Coffin D, Gouider E, Konkle B. et al; World Bleeding Disorders Registry Participating Investigators. The World Federation of Hemophilia World Bleeding Disorders Registry: insights from the first 10,000 patients. Res Pract Thromb Haemost 2023; 7 (08) 102264
- 71 Ndoumba-Mintya A, Diallo YL, Tayou TC, Mbanya DN. Optimizing haemophilia care in resource-limited countries: current challenges and future prospects. J Blood Med 2023; 14: 141-146
- 72 Shamoon RP. Magnitude of arthropathy in patients with hemophilia: a single-center experience. Iraqi Journal of Hematology 2017;6(02):
- 73 Valentino LA. Blood-induced joint disease: the pathophysiology of hemophilic arthropathy. J Thromb Haemost 2010; 8 (09) 1895-1902
- 74 Lafeber FP, Miossec P, Valentino LA. Physiopathology of haemophilic arthropathy. Haemophilia 2008; 14 (Suppl. 04) 3-9
- 75 Cross S, Vaidya S, Fotiadis N. Hemophilic arthropathy: a review of imaging and staging. Semin Ultrasound CT MR 2013; 34 (06) 516-524
- 76 Foppen W, Fischer K, van der Schaaf IC. Imaging of haemophilic arthropathy: awareness of pitfalls and need for standardization. Haemophilia 2017; 23 (05) 645-647
- 77 Kerr R. Imaging of musculoskeletal complications of hemophilia. Semin Musculoskelet Radiol 2003; 7 (02) 127-136
- 78 Masih S, Antebi A. Imaging of pigmented villonodular synovitis. Semin Musculoskelet Radiol 2003; 7 (03) 205-216
- 79 Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics 2008; 28 (05) 1493-1518
- 80 Al-Nakshabandi NA, Ryan AG, Choudur H. et al. Pigmented villonodular synovitis. Clin Radiol 2004; 59 (05) 414-420