Abstract
ObjectiveTo determine the usefulness of power Doppler (PD) ultrasound (US) to predict rheumatoid arthritis (RA) development in patients with clinically suspect arthralgia (CSA).MethodsRetrospective analysis of a US unit cohort over a 1-year period. Patients with CSA and no previous diagnosis of inflammatory arthritis (IA) were included for analysis. All underwent bilateral US examination of the hands and/or feet according to the EULAR guidelines. Active US inflammation was defined as PD synovitis and/or tenosynovitis ≥1 at any location. RA diagnosis according to clinician criteria 6 months after the US examination was checked. Univariate and multivariate logistic regression models were employed to investigate possible predictive factors of RA development.ResultsA total of 110 CSA patients (80 females, mean age 53.6 years) were included for analysis. After 6 months of follow-up, 14 (12.7%) developed RA and 34 (30.9%) IA. US active inflammation was present in 38 (34.5%) patients (28.2% showed PD synovitis and 18.2% PD tenosynovitis). Multivariate analysis showed that ACPA (OR 1.0003; 95% CI 1.002–1.006) and ESR (OR 1.054; 95% CI 1.016–1.094) were significantly associated with the detection of US active inflammation at baseline. Only PD tenosynovitis was found to be an independent predictive factor of an evolution towards RA (OR 6.982; 95% CI 1.106–44.057) and IA (OR 5.360; 95% CI 1.012–28.390).ConclusionUS is able to detect features of subclinical inflammation in CSA patients, especially in those with higher ESR and ACPA values. Only PD tenosynovitis at baseline US assessment was found to be an independent predictor of RA and IA development in CSA patients.
Highlights
The prompt diagnosis and early initiation of diseasemodifying antirheumatic drugs (DMARDs) improve long-term outcomes of rheumatoid arthritis (RA) patients [1, 2]
We have evaluated the potential usefulness of US as a predictor for RA development in patients presenting with clinically suspect arthralgia (CSA) in addition to serological markers
One over three patients presenting with CSA showed subclinical inflammation by US, and power Doppler (PD) tenosynovitis findings at the patient level were significantly associated with the evolution towards RA and inflammatory arthritis (IA)
Summary
The prompt diagnosis and early initiation of diseasemodifying antirheumatic drugs (DMARDs) improve long-term outcomes of rheumatoid arthritis (RA) patients [1, 2]. Molina Collada et al Arthritis Research & Therapy (2021) 23:299 satisfy the fulfilment of the classification at an early stage of the disease and, consecutively, a prompt treatment initiation [8, 9]. It is difficult to identify patients with CSA who would benefit from an early initiation of DMARD therapy because only those who will develop RA or other inflammatory arthritis (IA) would benefit from such an early intervention, so a prompt detection of inflammation and the identification of predictor factors of RA to avoid treating patients without persistent arthritis is desirable. Secondary objectives include to describe the frequency and pattern of US active inflammation in these patients and investigate factors associated with the detection of US inflammation
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