OP0217 IS METACARPOPHALANGEAL-JOINT PAIN AS AN EARLY SYMPTOM OF PATIENTS AT RISK FOR PROGRESSION TO INFLAMMATORY ARTHRITIS EXPLAINED BY MRI-DETECTED SUBCLINICAL INFLAMMATION? – A LARGE OBSERVATIONAL STUDY

Background:Pain in metacarpophalangeal (MCP)-joints in patients presenting with clinically suspect arthralgia (CSA) is one of the clinical features by which patients are considered at risk for progression to inflammatory arthritis (IA). As such this symptom is characteristic for CSA and therefore part of a list of clinical parameters determined by an EULAR-taskforce to identify a more homogeneous group of patients within CSA (the EULAR definition of arthralgia suspicious for progression to RA). MRI-detected subclinical inflammation is known to be present in patients with CSA. In general, arthralgia in CSA can be explained by this subclinical inflammation, however to date, the association of subclinical inflammation with pain in MCP-joints specifically is not clear. Subsequently, it is unknown whether this association differs pertinently when investigated with self-reported pain, or with pain in the form of tenderness at physical examination.Objectives:This study will investigate whether MCP-pain and MCP-joint tenderness are associated with MRI-detected subclinical inflammation in patients with CSA, and more specifically those who have progressed to IA.Methods:Between April 2012- February 2019, 602 patients were consecutively included in the Leiden clinically suspect arthralgia (CSA)-cohort. Follow-up ended when patients developed clinically apparent IA (determined at physical examination), or else after 2-years (median follow-up time 25 months). MCP-joints were assessed for self-reported joint pain by the patient using a mannequin and subsequently for joint tenderness by physical examination. Baseline unilateral MRIs of the MCP (2-5)-joints were scored by two readers, blinded for clinical data, on subclinical inflammation (synovitis, tenosynovitis, osteitis). Associations between MCP-pain or MCP-joint tenderness and MRI-detected subclinical inflammation were studied at patient level by logistic regression analyses, entering the mentioned MRI-detected features separately (univariable) and together (multivariable).Results:33% of 227 patients with self-reported MCP-pain had MRI-detected subclinical inflammation and 38% of 226 patients with MCP-joint tenderness had MRI-detected subclinical inflammation. Self-reported MCP-joint pain was univariable associated with subclinical inflammation and synovitis in particular (OR 2.00, 95% CI: 1.21-3.30, OR 2.87, 95% CI: 1.29-6.39). In multivariable analysis this MCP-pain was associated with synovitis (OR 2.54, 95% CI: 1.12-5.77). MCP-joint tenderness was univariable associated with subclinical inflammation, and synovitis and tenosynovitis in particular (OR 1.84, 95% CI: 1.29-2.63, OR 1.76, 95% CI: 1.10-2.81, OR 1.69, 95% CI: 1.12-2.55, respectively). In multivariable analysis, tenosynovitis remained significant (OR 1.54, 95% CI: 1.00-2.36). Of all patients with self-reported MCP-joint pain who developed IA, 50% had MRI-detected subclinical inflammation. For MCP-joint tenderness this was 61%. Patients with MCP-joint tenderness without subclinical inflammation who developed IA, developed clinical arthritis at a joint that was not scanned (85%), hence they may have had subclinical inflammation that was not imaged. The other 15% did develop arthritis in an MCP-joint, suggesting that subclinical inflammation developed after CSA-onset.Conclusion:Arthralgia in the MCP-joints is associated with subclinical inflammation in CSA, in particular with synovitis and tenosynovitis. The prevalence of subclinical inflammation is highest for tender joints at physical examination; this can be acknowledged when applying the EULAR definition of arthralgia suspicious for progression to RA.Disclosure of Interests:None declared

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Migratory non-itchy rash

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1282 ◽

2021 ◽

Vol 2 (4) ◽

Author(s):

Sami Hoshi ◽

Keyword(s):

Physical Examination ◽

Complete Resolution ◽

Endemic Region ◽

The West ◽

Western Blot Test ◽

Joint Tenderness ◽

Mucous Membranes ◽

The Usa ◽

History Of

A 58-year-old man presented with 4-day history of multiple, erythematous, non-itchy, painless, patchy spots, along with fatigue and jaw pain. This rash started around the periumbilical area and then spread over his chest and right upper back (Figure 1,2). There was no involvement of face, mucous membranes, and extremities. He denied any sore throat, cough, or other symptoms. Besides the skin rash, his physical examination was unremarkable. There was no temporomandibular joint swelling, or joint tenderness. A month ago, he travelled along with the west coast of Michigan – a Lyme-endemic region of the USA and noted his exposure to mosquitoes. Shortly after his visit, he recalled having fever, chills, myalgia and a similar patchy groin rash which resolved in a few days. At that time, blood work by his family physician revealed mild transaminitis. At the current visit, repeat blood work and electrocardiogram were normal. A clinical diagnosis of early disseminated Lyme disease was made. Lyme Ab IgM and IgG were both elevated, as was his Western blot test. He was given a 10-day course of doxycycline. He reported complete resolution of his symptoms at follow up.

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Joint pain

10.1093/med/9780199568741.003.0062 ◽

2018 ◽

Author(s):

Pippa Watson

Keyword(s):

Differential Diagnosis ◽

Soft Tissue ◽

Joint Pain ◽

Inflammatory Arthritis ◽

Morning Stiffness ◽

Early Morning ◽

Joint Line ◽

Joint Effusion ◽

Joint Tenderness ◽

Soft Tissue Swelling

When a patient complains of pain confined to a joint or joints, they are said to have arthralgia. If, in addition, there is swelling of the joint, tenderness of the joint line to palpation, and limitation of movement, the patient is said to have an arthritis. It is important to establish if an arthritis is inflammatory or non-inflammatory, as this affects the differential diagnosis. Soft tissue swelling of the joint, the presence of a joint effusion, increased temperature of the joint, erythema of overlying skin, and early morning stiffness of at least 30 minutes duration are signs of an inflammatory arthritis.

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Development of Simple Clinical Criteria for the Definition of Inflammatory Arthritis, Enthesitis, Dactylitis, and Spondylitis: A Report from the GRAPPA 2014 Annual Meeting

The Journal of Rheumatology ◽

10.3899/jrheum.150129 ◽

2015 ◽

Vol 42 (6) ◽

pp. 1041-1043 ◽

Cited By ~ 2

Author(s):

Philip J. Mease ◽

Jane J. Park ◽

Amit Garg ◽

Dafna D. Gladman ◽

Philip S. Helliwell

Keyword(s):

Psoriatic Arthritis ◽

Physical Examination ◽

Inflammatory Arthritis ◽

Nominal Group Technique ◽

Musculoskeletal Disease ◽

Nominal Group ◽

Clinical Criteria ◽

Expert Clinician ◽

Primary Care Clinicians ◽

Definition Of

Rheumatologists are trained to determine the presence of musculoskeletal inflammation through history, physical examination, and if needed, laboratory tests and imaging. However, primary care clinicians, dermatologists, surgeons, and others who may initially see patients with musculoskeletal pain are not necessarily able to make the distinction between inflammatory (e.g., rheumatoid arthritis or psoriatic arthritis) and noninflammatory disease (osteoarthritis, traumatic or degenerative tendonitis, back pain, or fibromyalgia). If such clinicians could more readily suspect and identify possible inflammatory musculoskeletal disease, it would lead to more timely diagnosis and triage to rheumatologists for diagnosis and appropriate management. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has been developing evidence-based, practical and reliable criteria that can be used by clinicians to identify inflammatory musculoskeletal disease. The research initiative involves a sequential process of expert clinician nominal group technique, patient focus groups, and Delphi exercises to identify core definitive features of inflammatory disease. The goal is to develop simple clinical criteria (history and physical examination elements) to identify inflammatory arthritis, enthesitis, dactylitis, and spondylitis and distinguish these from degenerative, mechanical, or other forms of these conditions, to achieve more timely and accurate diagnosis and referral of patients with inflammatory arthritis.

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368 Serial vs. single cardiovascular screening of adolescent athletes

European Heart Journal Supplements ◽

10.1093/eurheartj/suab144.003 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Patrizio Sarto ◽

Alessandro Zorzi ◽

Laura Merlo ◽

Teresina Vessella ◽

Cinzia Pegoraro ◽

...

Keyword(s):

At Risk ◽

Physical Examination ◽

Ventricular Arrhythmias ◽

Diagnostic Yield ◽

Competitive Sports ◽

Veneto Region ◽

Cardiovascular Screening ◽

Study Population ◽

Inherited Cardiomyopathies

Abstract The primary objective of preparticipation cardiovascular evaluation (PPCE) in young athletes is to detect asymptomatic individuals with cardiovascular disease (CVD) at risk of sudden cardiac death (SCD). The study population included a consecutive series of competitive athletes age 12–18 years who underwent PPCE, which according to Italian law is mandatory and based on yearly evaluations, at the Center for Sports Medicine of Treviso (Veneto region of Italy), from 2009 to 2019. The screening protocol included personal and family history questionnaire, physical examination, resting 12-lead ECG, and limited stress testing for evaluation of exertional ventricular arrhythmias. 2,3 This latter test was performed using a bicycle with constant-load increases (i.e. 2 W/kg in female participants and 3 W/kg in male participants) for 3 min for at least 85% or more of maximal heart rate was achieved, plus 3 min of postexercise monitoring. 3 Athletes with a positive medical history and abnormal physical examination, ECG, or stress test underwent further investigations. The diagnostic yield of the initial screening session was compared with that of repeat PPCEs. Athletes with a definitive diagnosis of CVD at risk of SCD were considered ineligible for competitive sports, although they received a tailored programme for leisure physical activity and were enrolled in a yearly follow-up programme. Outcome data of screened athletes, either eligible or ineligible to play competitive sports, were obtained from office visits, hospital records, or interrogation of the Registry of Juvenile SCD of the Veneto region. The study population included 15 127 consecutive athletes (64% male, 96% White) who underwent a total of 53 396 annual PPCEs (mean 3.7 per athlete) over the 11-year study period. The median age at first screening was 13 years [interquartile range (IQR): 12–14]. Sixty-three athletes (65% male) were diagnosed with a CVD at risk of SCD such as congenital heart disease (n = 17), ion channel disease (n = 11), inherited cardiomyopathy (n = 13), isolated nonischaemic left ventricular scar (NLVS) with ventricular arrhythmias (n = 18), or other (n = 4); 266 athletes had cardiac conditions not associated with SCD. Seventeen of the 63 athletes (27%) with atrisk CVD had a positive family history, symptoms, or abnormal physical examination, 38 (60%) had ECG abnormalities, and 32 (51%) developed arrhythmias on limited exercise testing. CVDs more frequently identified on repeat evaluation included inherited cardiomyopathies [7/11 (64%)], NLVS with ventricular arrhythmias [15/18 (83%)], and long QT syndrome [7/11 (64%)]. During a mean follow-up of 6.7 ± 3.5 years, 1 athlete with a negative PPCE experienced an episode of aborted SCD attributable to ventricular fibrillation that remained unexplained after a comprehensive diagnostic workup (event rate, 0.98/100 000 athletes per year). These results show that annual cardiovascular screening of adolescent athletes increased by three times the diagnostic yield of CVD at risk of SCD compared with a once-only (initial) evaluation. Inherited cardiomyopathies and isolated NLVS with ventricular arrhythmias were the CVDs more frequently identified on repeat evaluation.

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P4377Use of LV Deformation Imaging to predict long term Heart Failure Risk in high risk patients

European Heart Journal ◽

10.1093/eurheartj/ehz745.0782 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Haji ◽

T Marwick ◽

C Neil ◽

S Stewart ◽

M Carrington ◽

...

Keyword(s):

Heart Failure ◽

At Risk ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Multivariable Analysis ◽

P Value ◽

Ageing Population ◽

Patients At Risk

Abstract Background The increasing prevalence of heart failure (HF), due to hypertension, ischaemic heart disease, diabetes, obesity, and ageing population demands identification of at-risk subgroup whom we could target on prevention strategies. In a same cohort of patients at risk of HF (70% with CAD), 13% developed new HF hospitalization or death over 4.3 years of follow-up, however, disease management program did not confer any benefit to outcome and LV ejection fraction (EF) was not predictive of progression to HF. Better risk stratification strategies are needed. In this study, we sought whether advanced echo measure on deformation, global longitudinal strain (GLS) would predict HF admission over a long term follow up and thereby define an at-risk group. Aim: To determine which of the LV morphology, function and deformation parameters, best predict new HF admission or HF death in pts at risk but without prior dx of HF. Method Echocardiograms (including measurement of LV, size, function, morphology and deformation) were obtained in 431 inpatients (mean age 65±11, 72% male) at risk of HF. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured offline (EchoPac, GE). Long term (9 years) follow up data were obtained via data linkage. Results 63 pts (15%) reached the end-point of HF admission or HF death. LV deformation showed a univariable association with outcome (Table). In multivariable analysis, including known significant predictors of outcome (age, sex, BMI, diabetes, hypertension), GLS less than 18 remained an independent predictor (Table), in addition to age and DM at baseline. EF and LV mass were not predictors of heart failure. HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Age 1.1 (1–1.1) <0.01 1.1 (1–1.1) 0.04 1 (1–1.1) 0.04 Sex 1.0 (0.6–1.7) 0.9 0.8 (0.4–1.8) 0.6 0.8 (0.4–1.8) 0.6 BMI 1.0 (1–1.1) 0.05 1 (0.9–1.1) 0.7 1 (0.9–1.1) 0.7 DM 2.6 (1.6–4.3) <0.01 2.7 (1.4–5.3) <0.01 2.7 (1.4–5.2) 0.04 LVMI 1.0 (1.0–1.0) <0.01 1 (0.9–1.0) 0.7 1 (0.99–1.0) 0.7 Impaired EF, % 1.0 (0.9–1.0) <0.01 1 (0.9–1.0) 0.16 0.97 (0.94–1.0) 0.04 Diastolic dysfunction 2.3 (1.4–3.7) <0.01 0.8 (0.3–1.7) 0.5 0.7 (0.3–1.7) 0.5 GLS 1.3 (1.4–1.2) <0.01 1.1 (1–1.2) 0.07 GLS <18 5.3 (2.8–10.2) <0.01 2.3 (1.1–5.1) 0.04 Conclusion GLS <18 is independently associated with increasing new onset heart failure admission and HF mortality in patients at risk of HF.

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P239 Third generation APCA improve prediction of clinical arthritis in at-risk individuals with positive second generation ACPA

Rheumatology ◽

10.1093/rheumatology/keaa111.233 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Andrea Di Matteo ◽

Kulveer Mankia ◽

Laurence Duquenne ◽

Michael Mahler ◽

Diane Corscadden ◽

...

Keyword(s):

At Risk ◽

Inflammatory Arthritis ◽

Second Generation ◽

Third Generation ◽

Serum Samples ◽

Incremental Value ◽

Rate Of Progression ◽

Clinical Arthritis ◽

Citrullinated Peptide

Abstract Background Anti-citrullinated peptide antibodies (ACPA) are important biomarkers in rheumatoid arthritis (RA) and can predict arthritis development in at-risk individuals. ACPA are conventionally detected using the second-generation or third generation IgG anti-CCP antibody (Ab) assays. Although the value of anti-CCP2 Ab for predicting progression to RA in at-risk individuals is well understood, very little knowledge exists for anti-CCP3.The objectives of this study were: i) To evaluate the prevalence of serum anti-CCP3 Ab in serum anti-CCP2 Ab positive at-risk individuals (CCP2+ at-risk); ii)) To study the incremental value of anti-CCP3 Ab in CCP2+ at-risk subjects for predicting progression to clinical inflammatory arthritis (IA). Methods Anti-CCP3 Ab were tested on stored serum samples obtained from 347 CCP2 + (BioRad, USA) at-risk individuals from the Leeds CCP study. Anti-CCP2 and anti-CCP3 tests positivity threshold was >2.99 IU/ml and >20 units, respectively. Moreover, anti-CCP2 and anti-CCP3 titres were categorised according to manufacturer’s cut-off: low (LT) and high (HT) for anti-CCP2, negative/weak/moderate/strong for anti-CCP3. Progression to IA was defined as the development of clinical synovitis in at least one joint. Only subjects with at least one follow-up visit were included in the progression analysis (n = 317). Results Anti-CCP3 Ab were negative in 138/347 (39.7%) CCP2+ individuals, and weakly, moderately, and strongly positive in 15/347 (4.3%), 5/347 (1.4%) and 189/347 (54.4%) individuals, respectively. LT and HT anti-CCP2 Ab were found in 103/347 (29.7%) and in 244/347 (70.3%) individuals, respectively. Eighty-eight/317 subjects (28%) developed IA. The rate of progression of LT and HT anti-CCP2, when anti-CCP3 was negative, decreased from 6.5% to 2.7%, and from 36.6% to 9.4%, respectively. Progression in anti-CCP2 HT increased from 36.6% to 45.6% when anti-CCP3 was positive (Table 1). Conclusion Our results support an important role for anti-CCP3 Ab in improving prediction of IA in CCP2+ at-risk individuals. Disclosures A. Di Matteo None. K. Mankia None. L. Duquenne None. M. Mahler Other; Inova Diagnostic. D. Corscadden None. K. Mbara None. L. Garcia-Montoya None. J. Nam None. P. Emery Honoraria; AbbVie, BMS, Bristol-Myers Squibb, Gilead, Lilly, MSD, Novartis, Pfizer, Roche, Samsung, Samsung Bioepis Co., Ltd.

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Predictors of good response to conventional synthetic DMARDs in early seronegative rheumatoid arthritis: data from the ESPOIR cohort

Arthritis Research & Therapy ◽

10.1186/s13075-019-2020-x ◽

2019 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Cédric Lukas ◽

Julia Mary ◽

Michel Debandt ◽

Claire Daïen ◽

Jacques Morel ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Inflammatory Arthritis ◽

Multivariable Analysis ◽

Imaging Features ◽

Eular Response ◽

Sharp Score ◽

Structural Progression ◽

Therapeutic Concepts ◽

Early Inflammatory Arthritis

Abstract Background and objective Early seronegative rheumatoid arthritis (RA) is considered a specific entity, especially regarding diagnostic issues and prognosis. Little is known about its potentially different initial clinical presentation and outcome. We aimed to determine predictors of good response to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) in seronegative RA patients with early inflammatory arthritis. Patients and methods Patients from the ESPOIR cohort with early inflammatory arthritis fulfilling the 2010 ACR/EULAR classification criteria for RA despite negativity for both rheumatoid factor and anti-CCP antibodies. The primary endpoint was a good or moderate EULAR response assessed after 1 year of follow-up, given at least 3 months of treatment with a csDMARD. Secondary objectives were to compare the early therapeutic response to methotrexate (MTX) and leflunomide (LEF) versus other csDMARDs (hydroxychloroquine, sulfasalazine) and to identify factors associated with functional disability (Health Assessment Questionnaire-Disability Index [HAQ-DI] > 0.5 at 1 year) and structural progression (van der Heijde-modified total Sharp score > 1 and > 5 points at 1 year). Logistic regression analysis was used to determine independent predictors of outcomes. Results One hundred seventy-two patients were analyzed. Overall, 98/172 (57%) patients received MTX during the first year of follow-up. A good or moderate EULAR response at 1 year was associated with early use of csDMARDs (i.e., within 3 months after the first joint swelling) on univariate and multivariable analysis (odds ratio = 2.41 [95% confidence interval 1.07–5.42], p = 0.03). Response rates were not affected by other classical prognostic factors (i.e., baseline DAS28). Presence of erosions at baseline was associated with Sharp score progression > 1 point and > 5 points (both p = 0.03) at 1 year. HAQ-DI ≥ 1 at inclusion and active smoking were significantly associated with HAQ-DI > 0.5 at 1 year. Conclusion Our results suggest that delay in initiation of csDMARD more than baseline clinical, biological, or imaging features predominantly affects the outcome in early seronegative RA. These findings confirm that the usual therapeutic concepts in RA (early treatment, tight control, and treat-to-target) should be applied similarly to both seropositive and seronegative disease forms. Trial registration ClinicalTrials.gov: NCT03666091. Registered September 11, 2018.

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Abstract WP224: Should Carotid Bruit Be Abandoned as a Marker of Carotid Stenosis and Cardiovascular Disease in Older Persons? The Cardiovascular Health Study

Stroke ◽

10.1161/str.51.suppl_1.wp224 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Adnan I Qureshi ◽

Omer Saeed ◽

Hunain Aslam

Keyword(s):

Cardiovascular Disease ◽

At Risk ◽

Ischemic Stroke ◽

Physical Examination ◽

Carotid Stenosis ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Elderly Persons

Importance: Auscultation for carotid bruit has been considered part of physical examination for over five decades. Objective: To test whether a carotid bruit (CB) can identify patients with internal carotid artery stenosis (50% or greater) and those at risk of myocardial infarction (MI), ischemic stroke and/or death among elderly persons. Methods: We analyzed data from the Cardiovascular Health Study a population-based, prospective observational cohort study of risk factors for cardiovascular disease in adults 65 years or older. CB was auscultated and maximum percent stenosis was assessed using duplex ultrasound at baseline visit. Longitudinal follow-up was conducted for a mean (SD) of 13 (6.2) years to identify incidence of ischemic stroke, MI and death using annual extensive clinical examinations and 6 monthly clinic visits, and contact by phone to ascertain occurrence of cardiovascular events. We performed Cox proportional hazards analysis to determine the effect of CB on incidence of MI, stroke and death during follow up after adjusting for potential confounders. Results: The mean (SD) age of the entire cohort (n = 5888) was 72.8 (5.6) years; 2466 (41.9%) were men. CB was identified in 361 (6.1%) of 5888 persons. Carotid stenosis (50% or greater) was identified in 79 of 361 person with CB (sensitivity of 28.6%). No CB was auscultated in 197 out of 276 patients with carotid stenosis (specificity of 94%). During follow-up, higher proportion of persons with CB experienced ischemic stroke (10.8% versus 7.2%, p=.01), MI (15.0% versus 8.9%,p=<.0001) and death (36.3% versus 21.7%,p=<.0001). There were no differences in the risk of stroke (HR 1.2, 95% CI 0.9-1.5) between persons with CB compared with those without CB in the multivariate analysis after adjusting for age, gender, race hypertension, diabetes and smoking. There was a significantly higher rate of death among persons with CB (HR 1.3, 95% CI (1.1-1.5; p-<.01) and MI (HR 1.4, 95% CI 1.0-1.8; p-.03) compared with those who did not after adjusting for potential confounders. Conclusions: In this study, CB was a not a reliable marker for identification of carotid stenosis and those at risk for ischemic stroke. The current analysis does not support continued use of carotid bruit as part of physical examination.

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Ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti-CCP positive at-risk individuals without clinical synovitis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-217215 ◽

2020 ◽

Vol 79 (7) ◽

pp. 901-907 ◽

Cited By ~ 4

Author(s):

Andrea Di Matteo ◽

Kulveer Mankia ◽

Laurence Duquenne ◽

Edoardo Cipolletta ◽

Richard J Wakefield ◽

...

Keyword(s):

At Risk ◽

Inflammatory Arthritis ◽

Power Doppler ◽

High Titre ◽

Peptide Antibody ◽

Clinical Arthritis ◽

Citrullinated Peptide ◽

Power Doppler Signal ◽

Subclinical Synovitis

ObjectivesTo investigate, in anti-cyclic citrullinated peptide antibody positive (CCP+) at-risk individuals without clinical synovitis, the prevalence and distribution of ultrasound (US) bone erosions (BE), their correlation with subclinical synovitis and their association with the development of inflammatory arthritis (IA).MethodsBaseline US scans of 419 CCP+ at-risk individuals were analysed. BE were evaluated in the classical sites for rheumatoid arthritis damage: the second and fifth metacarpophalangeal (MCP2 and MCP5) joints, and the fifth metatarsophalangeal (MTP5) joints. US synovitis was defined as synovial hypertrophy (SH) ≥2 or SH ≥1+power Doppler signal ≥1. Subjects with ≥1 follow-up visit were included in the progression analysis (n=400).ResultsBE were found in ≥1 joint in 41/419 subjects (9.8%), and in 55/2514 joints (2.2%). The prevalence of BE was significantly higher in the MTP5 joints than in the MCP joints (p<0.01). A significant correlation between BE and US synovitis in the MTP5 joints was detected (Cramer’s V=0.37, p<0.01). The OR for the development of IA (ever) was highest for the following: BE in >1 joint 10.6 (95% CI 1.9 to 60.4, p<0.01) and BE and synovitis in ≥1 MTP5 joint 5.1 (95% CI 1.4 to 18.9, p=0.02). In high titre CCP+ at-risk individuals, with positive rheumatoid factor and BE in ≥1 joint, the OR increased to 16.9 (95% CI 2.1–132.8, p<0.01).ConclusionsIn CCP+ at-risk individuals, BE in the feet appear to precede the onset of clinical synovitis. BE in >1 joint, and BE in combination with US synovitis in the MTP5 joints, are the most predictive for the development of clinical arthritis.

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