The role of ultrasound-defined tenosynovitis and synovitis in the prediction of rheumatoid arthritis development

Research output: Contribution to journalArticlepeer-review

Colleges, School and Institutes

External organisations

  • University Hospitals Birmingham NHS Foundation Trust
  • Sandwell and West Birmingham Hospitals NHS Trust
  • University of Oxford
  • Division of Gastroenterology and Hepatology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
  • MRC-ARUK Centre for Musculoskeletal Ageing Research; School of Immunity and Infection; Birmingham University Medical School; Birmingham B15 2TT UK


Objectives: Tenosynovitis (TS) is common in early arthritis. However, the value of US-defined TS in predicting RA development is unclear. We assessed the predictive utility of US-defined TS alongside US-defined synovitis and clinical and serological variables in a prospective cohort of early arthritis patients.

Methods: One hundred and seven patients with clinically apparent synovitis of one or more joint and symptom duration ⩽3 months underwent baseline clinical, laboratory and US assessment of 19 bilateral joint sites and 16 bilateral tendon compartments. Diagnostic outcome was determined after 18 months, applying the 2010 ACR/EULAR classification criteria for RA. The predictive values of US-defined TS for persistent RA were compared with those of US-defined synovitis, clinical and serological variables.

Results: A total of 4066 US joint sites and 3424 US tendon compartments were included in the analysis. Forty-six patients developed persistent RA, 17 patients developed non-RA persistent disease and 44 patients had resolving disease at follow-up. US-defined TS in at least one tendon compartment at baseline was common in all groups (RA 85%, non-RA persistent disease 71% and resolving 70%). On multi-variate analysis, US-defined digit flexor TS provided independent predictive data over and above the presence of ACPA and US-defined joint synovitis.

Conclusion: US-defined digit flexor TS provided independent predictive data for persistent RA development in patients with early arthritis. The predictive utility of this tendon site should be further assessed in a larger cohort; investigators designing imaging-based predictive algorithms for RA development should include this tendon component as a candidate variable.


Original languageEnglish
Pages (from-to)1243–1252
Number of pages10
Issue number7
Early online date3 Apr 2018
Publication statusPublished - 1 Jul 2018


  • Tenosynovitis, Ultrasound, Rheumatoid arthritis, Synovitisa