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

Abstract

Objectives: The value of US-defined tenosynovitis in predicting the persistence of inflammatory arthritis is not well described. In particular, the predictive utility of US-defined tenosynovitis of larger tendons is yet to be reported. We assessed the value of US-defined tenosynovitis alongside US-defined synovitis and clinical and serological variables in predicting persistent arthritis in an inception cohort of 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 of ≤3 months underwent baseline clinical, laboratory and US (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 US-defined tenosynovitis for persistent arthritis was compared with those of US-defined synovitis, and 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 US-detected digit flexor tenosynovitis [odds ratio (OR): 6.6, 95% CI: 2.0 , 22.1, P = 0.002] provided independent predictive data for persistence over and above the presence of US-detected joint synovitis and RF antibodies. In the RF/ACPA-negative subcohort, US-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 US-defined joint synovitis.

Conclusion: US-defined tenosynovitis provided independent predictive data for the development of persistent arthritis. The predictive role of US-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.

Keywords: early arthritis; persistent arthritis; prediction; ultrasound.

Fig. 1

Distribution of joint US pathology (grayscale and power Doppler) for all patients (n = 150) Each bar represents the proportion of patients with US-defined synovitis involvement according to outcome groups. Data available for GS: n = 149; for MCP 2–5, PIP 1–5, MTP 2–3 and wrist; n = 148 for MTP 4–5; n = 107 for elbow, shoulder, ankle and knee. Data available for power Doppler n = 149 for MCP 3–4, PIP 1–5 and wrist; n = 148 for MTP 2–3; n = 147 for MTP 4–5; n = 107 for elbow, shoulder, ankle and knee. *P ≤0.05, (Fisher’s exact test). GS: grayscale.

Fig. 2

Distribution of US pathology by tendon region and wrist tendon compartment for all patients Each bar represents the proportion of patients’ US-defined tenosynovitis involvement according to tendon region individual (GS: 2A and power Doppler: 2B) and wrist extensor compartments (GS: 2C and power Doppler: 2D). Data available n = 113 for wrist extensor; n = 111 for digit flexor; n = 107 for shoulder biceps, ankle extensor, ankle peroneal, ankle posterior tibial and wrist flexor; n = 113 for ECU; n = 107 for EDM, EDC/EIP, EPL, ECRL/ECRB and APL/EPB. *P≤0.05, (Fisher’s exact test). APL: abductor pollicis longus; ECRB: extensor carpi radialis brevis; ECRL: extensor carpi radialis longus; ECU: extensor carpi ulnaris; EDC: extensor digitorum communis; EDM: extensor digiti minimi; EIP: extensor indicis propius; EPB: extensor pollicis brevis; EPL: extensor pollicis longus.