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Musculoskeletal ultrasound (US) has become a more widely used tool in rheumatology clinical practice. This study of early inflammatory arthritis patients shows that US-defined digit flexor tenosynovitis (TS) was more predictive of subsequent rheumatoid arthritis (RA) than findings of ACPA positivity or US-defined joint synovitis.
A cohort of 107 early arthritis patients underwent baseline clinical, laboratory and US assessment of 19 bilateral joint sites and 16 bilateral tendon compartments. Ultimate outcomes were determined 18 months later using the 2010 ACR/EULAR classification criteria for RA.
A total of 46/107 patients developed persistent RA, 17 patients developed non-RA persistent disease and 44 patients had resolved their disease at follow-up.
US-defined TS was more likely in RA, but was seen in all groups studied (RA 85%, non-RA persistent disease 71% and resolving 70%). RA patients were more likely to have grey scalle (GS) and power doppler (PD) changes at PIP 1–5, MCP 1–5, wrist, elbow, MTP 3 and MTP 5 joints. In addition, RA patients were more likely to have MTP 2 PD changes, but not GS changes alone, compared with patients with resolving arthritis.
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.