Ultrasound Scans of Tenosynovitis Predict Early RA

For the first time, a study shows that ultrasound diagnosis of tenosynovitis is superior to clinical signs and symptoms in the prediction of early rheumatoid arthritis (RA).

The results, presented at the 2015 European League Against Rheumatism (EULAR) Congress in Rome, suggest that ultrasound diagnosis has the potential to improve clinical outcomes by identifying the need for treatment before the onset of signs and symptoms of RA.

Previously, studies have shown that the clinical signs and symptoms of RA may be preceded by a preclinical phase that lasts several years. “This preclinical phase is likely to represent an important therapeutic window within which clinical outcomes can be dramatically improved,” said senior author Andrew Filer, MD, of the Rheumatology Research Group, University of Birmingham, UK.

Filer and colleagues set out to explore the ability of ultrasound-defined tenosynovitis to predict very early RA during the earliest undifferentiated phase of disease, Dr. Filer said.

The EULAR Study Group for Risk Factors for Rheumatoid Arthritis had previously recommended the need to identify new biomarkers for the prediction of RA in early undifferentiated disease.

The 107 patients included in the study had clinically apparent synovitis involving at least 1 joint, and symptom duration of 3 months or less.

They underwent clinical and multiple tendon ultrasound assessments. A blinded ultrasound assessment was carried out on each patient to determine the presence of tenosynovitis at 16 tendon regions: bilateral fingers (extensor and flexor compartments), wrists (extensor and flexor compartments), shoulders (biceps tendon), and ankles (anterior extensors, peroneals, and posterior tibialis).

The definition of tenosynovitis using grey scale and Power Doppler readings was based on the OMERACT Ultrasound Task Force recommendations.

Outcomes were determined after 18 months using 1987 American College of Rheumatology criteria.

The researchers compared the predictive values of ultrasound-defined tenosynovitis with clinical and serological variables.

At follow-up, 43 patients developed RA, 20 patients developed non-RA persistent disease, and 44 patients had resolving disease. A total of 1712 tendon regions in the 107 patients were included in the analysis.

All patient groups had evidence of tenosynovitis in 1 or more tendon compartments during baseline assessment. However, there were significant differences in the distribution of tendon involvement between the 3 groups, including the Extensor Carpi Ulnaris (ECU) tendon, which was more prominent in the RA group.

Results show that ultrasound diagnosis of tenosynovitis was superior to clinical signs and symptoms, such as early morning stiffness, symmetrical arthritis and hand joint arthritis, in predicting early RA.

The researchers concluded that “hand and ECU tendon scanning provides the optimal minimal ultrasound data to predict early RA.”

References:

Sahbudin I, Pickup L, Cader Z, et al. Ultrasound-defined tenosynovitis is a strong predictor of early rheumatoid arthritis. EULAR 2015; Rome: Abstract OP0015.