Background/Purpose: The urgent need for identifying imaging and serological markers that early predicts rheumatoid arthritis (RA) is clinically important. We aim to identify ultrasound findings that precedes arthritis onset in Anti-Citrullinated Protein Antibody (ACPA) positive subjects at risk for developing RA.

Methods: Patients with musculoskeletal complaints and a positive ACPA test were referred from primary-care units to the rheumatology department for specialized care. Those lacking arthritis by clinical and ultrasound (US) examination were included in the prospective Risk-RA program, and monitored by a multidisciplinary team. Hand (Wrists, MCP’s, PIP’s, DIP’s) and feet (symptomatic joints included), were US-assessed for synovial hypertrophy and Doppler activity according to the EULAR-OMERACT definitions. Hand tendons [extensor wrist tendon compartments (1-6) and flexor finger tendons (2-5)] were examined for signs of tenosynovitis (tendon sheath thickening and/or fluid, with/without Doppler activity). Serum samples from inclusion were analysed on a multiplex immunoassay.

Results: At inclusion, 66 Risk-RA patients [85% female, median(range) age 50(22-82)yrs] were US-evaluated, and followed until arthritis onset. Within 2½ yrs [median 8(1-27) months] from recruitment, 27 patients [41%, 86% female, median age 52(22-74) yrs] developed an arthritis diagnosis. Of these 27 patients, 7 had tenosynovitis detected by US at inclusion, and 7 more developed tenosynovitis at follow-up visits (n=14). At the time of diagnosis, 20 out of 27 patients presented with both tenosynovitis and synovitis.

Majority of patients with tenosynovitis (12 out of 14, 86%) and a minority without tenosynovitis (15 out of 52, 29%) developed arthritis, resulting in an increased relative risk of 3.0 (95% CI 1.8-4.8) to develop arthritis for those presenting with tenosynovitis at baseline or follow-up visits (p=0.001). The extensor-carpi-ulnaris wrist tendons (7 of 12 patients) and 2nd finger flexor-tendons (5 of 12 patients) were commonly affected.

Concentrations of the ACPA specific antibodies tended to be higher in tenosynovitis patients developing arthritis [n=12, median of 70(2-175) AU/ml for anti-CCP, median of 68(0-673) AU/ml for anti-CEP, median of 53(0-644) for anti-vimentin] as compared to those without tenosynovitis developing arthritis [n=15, median of 35(1-100) AU/ml for anti CCP, median of 12(0-1179) for anti-CEP, median of 29(0-332) for anti-vimentin]. Same trend was noted in tenosynovitis patients developing arthritis vs those without-tenosynovitis not-developing arthritis. The 2 tenosynovitis patients’ not developing arthritis had lower levels of the antibodies compared to the tenosynovitis patients that developed arthritis.

No significant differences were noted in other patient baseline characteristics in those with tenosynovitis versus those without tenosynovitis [86 vs 85 % female, median age 54(29-71)yrs vs 50(22-82)yrs, mean visual analogue scale pain 34 vs 31, mean CRP 2.7 vs 3.2; and tender joint count 1.2 vs 0.7].

Conclusion: Tenosynovitis detected by ultrasound is highly predictive of rapid arthritis onset in ACPA positive subjects at risk for developing arthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tenosynovitis-detected-by-ultrasound-predicts-arthritis-onset-in-individuals-at-risk-of-developing-rheumatoid-arthritis/