Ultrasound tenosynovitis predicts RA, inflammatory arthritis in suspected arthralgia
Tenosynovitis detected through power Doppler ultrasound predicts rheumatoid and inflammatory arthritis development in patients with clinically suspect arthralgia, according to data published in Arthritis Research & Therapy.
“Although EULAR has produced recommendations for using imaging in the diagnosis of RA, no consensus has been reached regarding the optimal ultrasound methodology that should be used, and high levels of standardization are still needed,” Juan Molina Collada, MD, consultant rheumatologist at Hospital Universitario Gregorio Marañón, in Madrid, and colleagues wrote. “Moreover, the threshold to define ultrasound pathology suggestive of inflammation is unclear, in particular for synovitis.”
To examine whether ultrasound predicts RA in patients with clinically suspect arthralgia (CSA), and analyze the factors associated with detecting ultrasound inflammation, Collada and colleagues conducted a retrospective analysis of 110 patients with CSA and no previous diagnosis of inflammatory arthritis, all from a rheumatology ultrasound outpatient clinic. Participants underwent bilateral ultrasound examination of the hands and/or feet, with active ultrasound inflammation defined as a power Doppler (PD) synovitis or tenosynovitis score greater than or equal to one. RA diagnosis was made at 6 months follow-up according to clinician criteria, and univariate and multivariate logistic regression models were used to analyze possible predictive factors of RA development.
After 6 months of follow-up, 12.7% of patients developed RA and 30.9% developed inflammatory arthritis, according to the researchers. Among the patients included within the study, 42.7% had ultrasound synovitis and/or tenosynovitis at any location, and34.5% of the patients were found to have ultrasound active inflammation.
“The most frequent ultrasound finding was PD synovitis in 31 (28.2%) patients followed by PD tenosynovitis in 20 (18.2%) patients,” Collada and colleagues wrote.
Through multivariate analysis, researchers found anti-cyclic citrullinated peptide antibody (OR 1.0003; 95% CI 1.002–1.006) and erythrocyte sedimentation rate (OR 1.054; 95% CI 1.016–1.094) were significantly associated with ultrasound active inflammation detected at baseline. However, PD tenosynovitis was the only independent factor found to be predictive of an evolution towards RA (OR 6.982; 95% CI 1.106–44.057) and inflammatory arthritis (OR 5.360; 95% CI 1.012–28.390).
“PD tenosynovitis may be used as a predictor of an evolution to RA and IA in patients with CSA,” Collada and colleagues wrote. “PD ultrasound examination could be helpful in the systematic assessment of [CSA] patients, especially those with high [erythrocyte sedimentation rate] and [anti-cyclic citrullinated peptide antibody] levels.”