Abstract
ObjectivesTenosynovitis (TS) is common in early arthritis. However, the value of US-defined TS in predicting RA development is unclear. We assessed the predictive utility of US-defined TS alongside US-defined synovitis and clinical and serological variables in a prospective cohort of early arthritis patients.MethodsOne hundred and seven patients with clinically apparent synovitis of one or more joint and symptom duration ⩽3 months underwent baseline clinical, laboratory and US assessment of 19 bilateral joint sites and 16 bilateral tendon compartments. Diagnostic outcome was determined after 18 months, applying the 2010 ACR/EULAR classification criteria for RA. The predictive values of US-defined TS for persistent RA were compared with those of US-defined synovitis, clinical and serological variables.ResultsA total of 4066 US joint sites and 3424 US tendon compartments were included in the analysis. Forty-six patients developed persistent RA, 17 patients developed non-RA persistent disease and 44 patients had resolving disease at follow-up. US-defined TS in at least one tendon compartment at baseline was common in all groups (RA 85%, non-RA persistent disease 71% and resolving 70%). On multi-variate analysis, US-defined digit flexor TS provided independent predictive data over and above the presence of ACPA and US-defined joint synovitis.ConclusionUS-defined digit flexor TS provided independent predictive data for persistent RA development in patients with early arthritis. The predictive utility of this tendon site should be further assessed in a larger cohort; investigators designing imaging-based predictive algorithms for RA development should include this tendon component as a candidate variable.
Highlights
Initiation of immunosuppressant therapy during the early phases of RA alters the trajectory of disease progression [1]
The predictive utility of this tendon site should be further assessed in a larger cohort; investigators designing imaging-based predictive algorithms for RA development should include this tendon component as a candidate variable
Forty-six patients (43%) developed persistent RA, 17 patients (16%) developed non-RA persistent inflammatory arthritis and the remaining 44 (41%) had a resolving disease course, including 10 patients who fulfilled the 2010 ACR/EULAR criteria for RA during the study period but whose disease had resolved by 18 months of follow-up
Summary
Initiation of immunosuppressant therapy during the early phases of RA alters the trajectory of disease progression [1]. Distinguishing individuals who are at risk of progressing to RA from those whose disease will regress amongst patients presenting with clinical arthritis within 12 weeks of symptom onset remains a challenge. Many current predictive algorithms for RA progression are based on clinical joint involvement, alongside clinical and serological variables [2]. Musculoskeletal US is a noninvasive and well-tolerated imaging technique and has been shown to improve the predictive ability of such algorithms [3, 4] due to the detection of subclinical synovitis [5]. The ability of US-defined TS to add data predictive of RA in patients with early clinically apparent synovitis is currently unknown
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