Colour Doppler ultrasonography evaluation of vascularization in the wrist and finger joints in rheumatoid arthritis patients and healthy subjects.

OBJECTIVES: To evaluate the presence of blood flow by colour Doppler ultrasonography (CDUS) in the wrist and finger joints of rheumatoid arthritis (RA) patients and healthy subjects and to define a cut-off value of CDUS resistive index (RI). METHODS: Forty-three patients with RA and 43 healthy controls were examined by CDUS. The wrists, second and third metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were evaluated in each patient and healthy subject. Spectral Doppler analysis was performed in order to characterize the type of flow and a mean RI was measured to define a cut-off level. The area under receiver operating characteristic curve was used to evaluate the screening method's performance. RESULTS: Flow was detected in 219 of the 430 total joints (50.9%) of RA patients (111 in the wrists, 49 in the MCP and 30 in the PIP joints). Healthy subjects had a quantifiable flow in 45 of the 430 joints (10.5%) and, in particular, 39 (86.4%) in the wrist, 5 (11.14%) in the MCP and 1 (2.2%) in the PIP joints. The intra- and inter-reader agreements for the detection of Doppler signal were very good (kappa 0.82 and 0.89, respectively). Mean RI values were 0.72±0.06 in RA patients and 0.86±0.06 in healthy subjects (p<0.01). At cut-off point of RI<0.79 the sensitivity was 89.6% and the specificity was 78.8% (positive likelihood ratio 4.22). CONCLUSION: DUS is a useful tool for the detection of abnormal blood flow in inflammatory joints of RA patients.

Health technology assessment: principles, methods and current status.

PURPOSE: This paper analyses the methodological and technical aspects of health technology assessment (HTA) as a tool for evaluating health technologies and procedures, with special reference to diagnostic imaging; describes the main experiences with HTA at the international and national level; outlines the most important HTA projects in Italy, and analyses the effects of HTA on health care strategies and policies. MATERIALS AND METHODS: The work was carried out in three phases. In the first phase, the authors analysed the principles, methods and instruments of HTA; in the second, they evaluated the current status of HTA in different countries; and in the third, they defined the impact of HTA on the decision-making process in health care. RESULTS: Since the 1970s, technological innovation has been accompanied by the development of methods for the multidisciplinary assessment of the technical, scientific, economic, ethical and social aspects inherent in the use of new technologies. The method is implemented at an international level by a network of public and private bodies that carry out HTA in support of health care policies. CONCLUSIONS: Because the application of HTA is still in its early stages in Italy, it is necessary to promote its development by drawing on consolidated international experiences.