---
title: "Infrared Thermography Protocol to Triage Rheumatology Referrals for Suspected Inflammatory Arthrit"
id: "pubmed-42133946"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42133946"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42133946/"
doi: "10.1097/RHU.0000000000002356"
published_at: "2026-08-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Infrared Thermography Protocol to Triage Rheumatology Referrals for Suspected Inflammatory Arthrit
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42133946
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42133946/)
- **DOI:** [10.1097/RHU.0000000000002356](https://doi.org/10.1097%2FRHU.0000000000002356)
- **Published At:** 2026-08-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study developed and piloted a standardized **infrared thermography (IRT)** protocol to detect joint-level inflammation and expedite rheumatology referrals from a primary care setting. - Participants included people with rheumatoid arthritis (RA), osteoarthritis (OA), and healthy controls who underwent **power Doppler ultrasound (PDUS)** and IRT to establish temperature cutoff points for inflamed joints. - IRT images were analyzed by manual segmentation with specialized software to determine surface joint temperatures; measurements showed strong interrater reliability. - Temperature cutoff values discriminating inflamed from noninflamed joints were identified for the **metacarpophalangeal (MCP)** and wrist joints (specific T center and T mean thresholds reported in the source). - In a pilot of 20 patients with hand or foot joint pain, 10 (50%) met IRT-based criteria and were fast-tracked to rheumatology; 8 of those 10 (80%) were seen within 4 weeks. - Diagnoses among referred patients included OA, gout, and calcium pyrophosphate deposition disease; the source does not report how many new cases of RA were confirmed. - Authors conclude IRT is a feasible, reliable screening tool to identify thermal abnormalities at the joint level that may warrant expedited rheumatologic evaluation, but they call for further research to refine referral protocols and optimize use. - Conflicts of interest: M.I.D. and J.R.C. received research support from Pfizer; M.I.D. has consultant fees from AbbVie and Boehringer Ingelheim; other authors declared none.
## Clinical Analysis & Structured Key Points
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Epub 2026 May 11. # Developing and Piloting a Standardized Thermography Protocol to Expedite Rheumatology Referrals for Possible Inflammatory Arthritis [Giovanna Rosas Chavez](https://pubmed.ncbi.nlm.nih.gov/?term=Rosas+Chavez+G&cauthor_id=42133946)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#full-view-affiliation-1 "Department of Medicine, Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL."), [Laura B Hughes](https://pubmed.ncbi.nlm.nih.gov/?term=Hughes+LB&cauthor_id=42133946)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#full-view-affiliation-2 "Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#full-view-affiliation-3 "East Alabama Health, East Alabama Rheumatology Center, Opelika, AL."), [Rahima Begum](https://pubmed.ncbi.nlm.nih.gov/?term=Begum+R&cauthor_id=42133946)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#full-view-affiliation-2 "Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL."), [Jeffrey R Curtis](https://pubmed.ncbi.nlm.nih.gov/?term=Curtis+JR&cauthor_id=42133946)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#full-view-affiliation-2 "Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL."), [Maria I Danila](https://pubmed.ncbi.nlm.nih.gov/?term=Danila+MI&cauthor_id=42133946)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#full-view-affiliation-2 "Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#full-view-affiliation-4 "Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL.") Affiliations Expand ### Affiliations * 1 Department of Medicine, Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL. * 2 Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL. * 3 East Alabama Health, East Alabama Rheumatology Center, Opelika, AL. * 4 Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL. * PMID: **42133946** * DOI: [ 10.1097/RHU.0000000000002356 ](https://doi.org/10.1097/rhu.0000000000002356) Item in Clipboard # Developing and Piloting a Standardized Thermography Protocol to Expedite Rheumatology Referrals for Possible Inflammatory Arthritis Giovanna Rosas Chavez et al. J Clin Rheumatol. 2026. Show details Display options Display options Format Abstract PubMed PMID J Clin Rheumatol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Clin+Rheumatol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Clin+Rheumatol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42133946/) . 2026 Aug 1;32(5):e166-e172. doi: 10.1097/RHU.0000000000002356. Epub 2026 May 11. ### Authors [Giovanna Rosas Chavez](https://pubmed.ncbi.nlm.nih.gov/?term=Rosas+Chavez+G&cauthor_id=42133946)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#short-view-affiliation-1 "Department of Medicine, Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL."), [Laura B Hughes](https://pubmed.ncbi.nlm.nih.gov/?term=Hughes+LB&cauthor_id=42133946)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#short-view-affiliation-2 "Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#short-view-affiliation-3 "East Alabama Health, East Alabama Rheumatology Center, Opelika, AL."), [Rahima Begum](https://pubmed.ncbi.nlm.nih.gov/?term=Begum+R&cauthor_id=42133946)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#short-view-affiliation-2 "Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL."), [Jeffrey R Curtis](https://pubmed.ncbi.nlm.nih.gov/?term=Curtis+JR&cauthor_id=42133946)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#short-view-affiliation-2 "Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL."), [Maria I Danila](https://pubmed.ncbi.nlm.nih.gov/?term=Danila+MI&cauthor_id=42133946)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#short-view-affiliation-2 "Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42133946/#short-view-affiliation-4 "Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL.") ### Affiliations * 1 Department of Medicine, Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL. * 2 Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL. * 3 East Alabama Health, East Alabama Rheumatology Center, Opelika, AL. * 4 Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL. * PMID: **42133946** * DOI: [ 10.1097/RHU.0000000000002356 ](https://doi.org/10.1097/rhu.0000000000002356) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objective:** Inflammatory arthritis, especially rheumatoid arthritis (RA), imposes substantial morbidity that diminishes quality of life and escalates health care costs when left untreated. Timely diagnosis and treatment are pivotal. However, limited access to rheumatologists underscores the importance of triaging referrals based on symptom severity. We developed a protocol for using infrared thermography (IRT) to detect joint inflammation and implemented it in an academic primary care clinic as a screening tool for rheumatology referrals. **Materials and methods:** We enrolled people with RA, osteoarthritis (OA), and controls to undergo joint power doppler ultrasound (PDUS) and IRT. IRT image analysis employed manual segmentation with specialized software to determine surface joint temperatures. IRT temperature cutoff points using PDUS as the gold standard for joint inflammation were established. Subsequently, we recruited people with hand or foot joint pain and fast-tracked to rheumatology those surpassing IRT cutoff points for joint inflammation. **Results:** Thirty-two people with RA, 10 with OA, and 9 controls were enrolled. Most participants (86.3%) were females, and 37.3% were black. Temperature measurements showed robust interrater reliability. Cutoff points at metacarpophalangeal (MCP) (T center ≥32.93 °C, T mean ≥32.67 °C) and wrist (T center ≥33.76 °C, T mean ≥33.79 °C) joints discriminated between inflamed and noninflamed joints. Of the 20 pilot participants, N = 10 (50%) were referred to rheumatology using IRT findings, with N = 8 (80%) seen within 4 weeks. Diagnoses included osteoarthritis, gout, and calcium pyrophosphate deposition disease. **Conclusion:** IRT demonstrates potential as a reliable tool for identifying inflamed joints and offers a feasible pathway for identifying patients with joint-level thermal abnormalities who may benefit from expedited rheumatologic evaluation. Further research is needed to refine IRT-based rheumatology referral protocols and optimize their utilization. **Keywords:** imaging; rheumatology; thermography; triage. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement M.I.D. and J.R.C. have received research support from Pfizer. M.I.D. has received consultant fees from AbbVie and Boehringer Ingelheim. The remaining authors declare no conflict of interest. ## Similar articles * [ The comparisons between thermography and ultrasonography with physical examination for wrist joint assessment in juvenile idiopathic arthritis. ](https://pubmed.ncbi.nlm.nih.gov/28248195/) Lerkvaleekul B, Jaovisidha S, Sungkarat W, Chitrapazt N, Fuangfa P, Ruangchaijatuporn T, Vilaiyuk S.Lerkvaleekul B, et al.Physiol Meas. 2017 May;38(5):691-700. doi: 10.1088/1361-6579/aa63d8. Epub 2017 Mar 1.Physiol Meas. 2017.PMID: 28248195 * [ Infrared thermography in the detection of arthritis: a systematic review of diagnostic performance compared with joint ultrasound. ](https://pubmed.ncbi.nlm.nih.gov/41817825/) Bastelberger J, Clasen M, Geber C, Offenbächer M, Hasseli R, Rodrigues GD, Schwarting A, Triantafyllias K.Bastelberger J, et al.Rheumatol Int. 2026 Mar 12;46(4):60. doi: 10.1007/s00296-026-06093-5.Rheumatol Int. 2026.PMID: 41817825Free PMC article. * [ Semi-quantitative analysis of rheumatoid finger joint synovitis using power Doppler ultrasonography: when to perform follow-up study after treatment consisting mainly of antitumor necrosis factor alpha agent. ](https://pubmed.ncbi.nlm.nih.gov/19936743/) Kamishima T, Sagawa A, Tanimura K, Shimizu M, Matsuhashi M, Shinohara M, Hagiwara H, Henmi M, Narita A, Terae S, Shirato H.Kamishima T, et al.Skeletal Radiol. 2010 May;39(5):457-65. doi: 10.1007/s00256-009-0824-5. Epub 2009 Nov 20.Skeletal Radiol. 2010.PMID: 19936743Clinical Trial. * [ Power Doppler ultrasound monitoring of response to anti-tumour necrosis factor alpha treatment in patients with rheumatoid arthritis. ](https://pubmed.ncbi.nlm.nih.gov/26070937/) Iagnocco A, Finucci A, Ceccarelli F, Perricone C, Iorgoveanu V, Valesini G.Iagnocco A, et al.Rheumatology (Oxford). 2015 Oct;54(10):1890-6. doi: 10.1093/rheumatology/kev211. Epub 2015 Jun 11.Rheumatology (Oxford). 2015.PMID: 26070937 * [ Clinical assessment of arthritic knee pain by infrared thermography. ](https://pubmed.ncbi.nlm.nih.gov/30375348/) Fokam D, Lehmann C.Fokam D, et al.J Basic Clin Physiol Pharmacol. 2018 Oct 31;30(3). doi: 10.1515/jbcpp-2017-0218.J Basic Clin Physiol Pharmacol. 2018.PMID: 30375348Review. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42133946) ## References 1. 1. Cutolo M, Kitas GD, van Riel PLCM. Burden of disease in treated rheumatoid arthritis patients: Going beyond the joint. Semin Arthritis Rheum. 2014;43:479–488. 2. 1. March L, Lapsley H. What are the costs to society and the potential benefits from the effective management of early rheumatoid arthritis? Best Prac Res Clin Rheumatol. 2001;15:171–185. 3. 1. Boehncke W-H, Menter A. Burden of disease: psoriasis and psoriatic arthritis. Am J Clin Dermatol. 2013;14:377–388. 4. 1. Battafarano DF, Ditmyer M, Bolster MB, et al. 2015 American College of Rheumatology Workforce Study: supply and demand projections of adult rheumatology workforce, 2015-2030. Arthritis Care Res (Hoboken). 2018;70:617–626. 5. 1. Cottrell E, Welsh V, Mallen C. Inflammatory arthritis: case review and primary care perspectives. Clin Rheumatol. 2012;31:739–744. Show all 25 references ## MeSH terms * Adult Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Adult%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Adult) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42133946/) * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42133946/) * Arthritis, Rheumatoid* / diagnosis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Arthritis%2C+Rheumatoid%2Fdiagnosis%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Arthritis%2C+Rheumatoid) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42133946/) * Arthritis, Rheumatoid* / diagnostic imaging Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Arthritis%2C+Rheumatoid%2Fdiagnostic+imaging%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Arthritis%2C+Rheumatoid) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42133946/) * Female Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Female%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Female) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42133946/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42133946/) * Male Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Male%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeS
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