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Original article
Ultrasound is not associated with the presence of systemic autoimmunity or symptoms in individuals at risk for rheumatoid arthritis
  1. Laure Brulhart1,
  2. Deshiré Alpízar-Rodríguez2,
  3. Michael S Nissen2,
  4. Pascal Zufferey3,
  5. Ileana Ciubotariu4,
  6. Gregory Fleury2,
  7. Ilias Lazarou2,
  8. Cem Gabay2 and
  9. Axel Finckh2
  1. 1Rheumatology, Hopital neuchatelois La Chaux-de-Fonds, La Chaux-de-Fonds, Switzerland
  2. 2Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
  3. 3RHU DAL, CHUV, Lausanne, Switzerland
  4. 4Rheumatology Division, Hôpital du Sacré-Coeur de Montréal (HSCM), Montreal, Quebec, Canada
  1. Correspondence to Dr Laure Brulhart; laure.brulhart{at}


Objective To identify whether musculoskeletal ultrasound (MSUS) abnormalities are associated with specific phases of rheumatoid arthritis (RA) development in individuals at risk of RA.

Methods This is a prospective cohort study of individuals at risk of developing RA, namely first-degree relatives of patients with RA (RA-FDRs) without evidence of established rheumatic disease at inclusion. The inflammatory activity on MSUS was assessed according to a validated score (SONAR). Active MSUS was defined as a total B-mode score greater than 8, including at least one joint with significant synovitis (grade 2 or 3) or significant synovial hyperaemia (Doppler score greater than 1). We used logistic regression to analyse associations between MSUS findings and recognised preclinical phases of RA development, adjusting for other demographic and biological characteristics.

Results A total of 273 RA-FDRs were analysed, of whom 23 (8%) were anticitrullinated protein autoantibodies-positive, 58 (21%) had unclassified arthritis and 96 (35%) had an active MSUS, which was only associated with unclassified arthritis (OR: 1.8, 95% CI 1.0 to 3.3).

Conclusion In individuals at risk of RA, active MSUS was associated with the presence of unclassified arthritis, but not with any of the earlier described phases of RA development. These findings do not support an indiscriminate use of ultrasound in a screening strategy for preclinical RA.

  • rheumatoid arthritis
  • ultrasonography
  • early rheumatoid arthritis

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  • Contributors LB, DA-R, AF and CG conceived the presented idea. DA-R and AF performed most of the statistics. All authors contributed to patient inclusion, discussed the results and contributed to the final manuscript. All authors have contributed to researching data for the article, discussion of its content, and writing, reviewing and editing the manuscript before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Ethics Committee of University Hospital of Geneva, Switzerland (CER 08-102), and all participants signed an informed consent before enrolment.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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