Tenosynovitis May Predict Rheumatoid Arthritis

Clinical signs and symptoms of RA may be preceded by a preclinical phase lasting several years.

Using an ultrasound to predict tenosynovitis may also predict early rheumatoid arthritis (RA), according to the results of a study presented at the European League Against Rheumatism Annual Congress (EULAR 2015) Press Conference in Rome, Italy earlier this summer.

Researchers from the United Kingdom examined 107 patients with clinically apparent synovitis of at least one joint and greater than 3 months symptom duration in order to explore tenosynovitis in RA patients compared to clinical and serological variables in an early RA cohort. The patients underwent clinical and multiple tendon ultrasound assessments.

The researchers determined the patients’ status 18 months after baseline measurements were taking. The investigators used the standard criteria laid out by the American College of Rheumatology in 1987.

The authors tested 16 tendon regions in the participants, which totaled 1,712 tendon regions: bilateral fingers (extensor and flexor compartments), wrists (extensor and flexor compartments), shoulders (biceps tendon), ankles (anterior extensors, peroneals, posterior tibialis) using a Siemens Acuson Antares scanner and 5-13 MHz linear array transducer. The researchers then compared the predictive values of ultrasound defined tenosynovitis to the clinical and serological variables.

In total, 43 patients developed RA (VERA), 20 patients developed non RA persistent disease (NRAP) and 44 patients had resolving disease at follow up meetings. Each patient group demonstrated evidence of tenosynovitis in one or more tendon region during their first assessment at rates of 86 percent, 75 percent, and 70 percent in the VERA, NRAP, and resolving disease groups, respectively.

The authors additionally noted that there were significant differences among the distribution of tendon involvement between the three groups including the Extensor Carpi Ulnaris tendon. The VERA group showed 54 percent involvement, while the NRAP groups and resolving disease group numbered 15 percent and 18 percent, respectively.

“There is a wealth of evidence that the clinical signs and symptoms of RA may be preceded by a preclinical phase lasting several years, and this preclinical phase is likely to represent an important therapeutic window within which clinical outcomes can be dramatically improved,” explained study author Andrew Filer, MD, PhD, in a press release.

This study, the authors said, is the first to demonstrate that ultrasound defined tenosynovitis is a strong predictor for early RA. Additionally, they believe that if clinicians and rheumatologists can identify the need for treatment prior to the onset of signs and symptoms, the procedure could positively influence clinical outcomes.

“Tenosynovitis ultrasound variables were superior to clinical variables (early morning stiffness, symmetrical arthritis, and hand joint arthritis) in the prediction of early RA,” the authors wrote in the journal the Annals of the Rheumatic Diseases.