The value of ultrasound–defined tenosynovitis and synovitis in the prediction of persistent arthritis

Ilfita Sahbudin, Ruchir Singh, Paola De Pablo, Elizabeth Rankin, Benjamin Rhodes, Elizabeth Justice, Emma Derrett-Smith, Esther Nicole Amft, Nehal Narayan, CM McGrath, Sangeetha Baskhar, Jeanette Trickey, Mark Maybury, Karim Raza, Andrew Filer

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Objectives: The value of ultrasound-defined tenosynovitis in predicting the persistence of inflammatory arthritis is not well described. In particular, the predictive utility of ultrasound-defined tenosynovitis of larger tendons is yet to be reported. We assessed the value of ultrasound-defined tenosynovitis alongside ultrasound-defined synovitis and clinical and serological variables in predicting persistent arthritis in an inception cohort of disease-modifying antirheumatic drug (DMARD)-naïve patients with early arthritis.

Methods: One hundred and fifty DMARD-naïve patients with clinically apparent synovitis of one or more joints and a symptom duration ⩽3 months underwent baseline clinical, laboratory and ultrasound (of 19 bilateral joints and 16 bilateral tendon compartments) assessments. Outcomes were classified as persistent or resolving arthritis after 18 months follow-up. The predictive value of ultrasound-defined tenosynovitis for persistent arthritis was compared with those of ultrasound-defined synovitis, clinical and serological variables.

Results: At 18 months, 99 patients (66%) had developed persistent arthritis and 51 patients (34%) had resolving disease. Multivariate logistic regression analysis showed that ultrasound-detected digit flexor tenosynovitis (OR:6.6,95%CI:2.0-22.1,p=0.002) provided independent predictive data for persistence over and above the presence of ultrasound-detected joint synovitis and rheumatoid factor antibodies. In the RF/ACPA-negative sub-cohort, ultrasound-defined digit flexor tenosynovitis remained a significant predictive variable (OR:4.7,95%CI:1.4-15.8,p=0.012), even after adjusting for ultrasound-defined joint synovitis.

Conclusion: Ultrasound-defined tenosynovitis provided independent predictive data for the development of persistent arthritis. The predictive role of ultrasound-defined digit flexor tenosynovitis should be further assessed; investigators should consider including this tendon site as a candidate variable when designing imaging-based predictive algorithms for persistent inflammatory arthritis development.
Original languageEnglish
Article numberkeac199
Number of pages13
JournalRheumatology (Oxford, England)
Early online date12 Apr 2022
Publication statusE-pub ahead of print - 12 Apr 2022

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VoR not yet published as of 20/09/2022


  • early arthritis
  • ultrasound
  • prediction
  • persistent arthritis


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