Tenosynovitis has a high sensitivity for early ACPA-positive and ACPA-negative RA: a large cross-sectional MRI study

Abstract

ObjectivesClinically evident tenosynovitis can be seen in established rheumatoid arthritis (RA). Imaging research has recently shown that tenosynovitis at small joints occurs in early RA, contributes to typical RA symptoms (including joint swelling) and is infrequent in healthy controls. Imaging-detectable tenosynovitis is often not recognisable at joint examination, hence its prevalence can therefore be underestimated. We hypothesised that if MRI-detectable tenosynovitis is a true RA feature, the sensitivity for RA is high, in both anti-citrullinated protein antibodies (ACPA)-positive and ACPA-negative RA, and lower in other diseases that are associated with enthesitis (such as spondyloarthritis (SpA) and psoriatic arthritis (PsA)). So far, no large MRI study addressed these questions.MethodsConsecutive patients with early arthritis (n=1211) from one healthcare region underwent contrast-enhanced 1.5T MRI of hand and foot at diagnosis. MRIs were scored for synovitis and tenosynovitis by two readers blinded for clinical data. All included patients with ACPA-positive RA (n=250), ACPA-negative RA (n=282), PsA (n=88), peripheral SpA (n=24), reactive arthritis (n=30) and self-limiting undifferentiated arthritis (UA; n=76) were studied. Sensitivity was calculated.ResultsThe sensitivity of tenosynovitis in RA was 85%; 88% for ACPA-positive RA and 82% for and ACPA-negative RA (p=0.19). The sensitivity for RA was significantly higher than for PsA (65%; p=0.001), SpA (53%; p<0.001), reactive arthritis (36%; p<0.001) and self-limiting UA (42%; p<0.001). The observed sensitivity of MRI synovitis was 91% in RA and ranged from 83% to 54% in other groups.ConclusionsMRI-detected tenosynovitis has a high sensitivity for early ACPA-positive and ACPA-negative RA. This supports that both juxta-articular (tenosynovitis) and intra-articular synovial involvement is characteristic of RA.

During development of rheumatoid arthritis, intermetatarsal bursitis may occur before clinical joint swelling: a large imaging study in patients with clinically suspect arthralgia

“…Although intra-articular synovitis is the most well-known characteristic of RA, recent studies illustrate that RA also frequently involves juxta-articular synovial inflammation, which was demonstrated for tenosynovitis [ 2 , 4 ]. Tenosynovitis already occurs in the phase of CSA and predicts progression to clinical arthritis [ 14 , 23 ].…”

An ultrasound negative for subclinical synovitis in arthralgia patients: is it helpful in identifying those not developing arthritis?

“…It was recently shown that especially the presence of power Doppler-positive synovitis, but also tenosynovitis, were predictive for the development of inflammatory arthritis in arthralgia patients [ 6 , 17 ]. Therefore, two different MSUS definitions were analysed: a more stringent definition for test positivity (power Doppler >0 regardless of the GS score) and alternatively a broader definition (subclinical synovitis and/or tenosynovitis in GS/power Doppler).…”

Association of Interosseous Tendon Inflammation in the Hand With Different Early Arthritides in a 10‐Year Magnetic Resonance Imaging Study

“…Patients. The Leiden Early Arthritis Cohort (EAC) is a Dutch inception cohort based in the Leiden University Medical Center (LUMC) that has enrolled patients with clinically apparent arthritis of recent onset since 1993 and was extensively described previously (4,14). All patients presenting with clinically apparent inflammatory arthritis were eligible, except for those with long-standing arthritis (symptom duration ≥2 years) or evident gout, inflammatory osteoarthritis (OA), or posttraumatic arthritis.…”

“…Similarly, the intermetatarsal bursae located between the MTP joints possess a synovial lining (3). Inflammation of these juxta-articular tissues (ie, tenosynovitis and intermetatarsal bursitis) is found in the majority of patients with RA and independently explains typical clinical features such as joint tenderness and swelling (4)(5)(6)(7). Moreover, tenosynovitis and intermetatarsal bursitis contribute to functional impairments (8,9).…”