Ultrasonography in the preclinical phase of RA
| Author, year | Study population | Cases (n) | Progression to arthritis (%) | Median duration from study entry to diagnosis of arthritis, months (IQR) | Median duration of follow-up, months (IQR) | Locations scanned | Ultrasound/measured factors | Controls used to define positive US | Main result | |||
| GS-US | PD-US | Tenosynovitis | Erosions | |||||||||
| van de Stadt et al, 201043 | ACPA+ and/or RF+ arthralgia (secondary care) | 192 | 45 (23) | 11 (9)* | 26 (6–54) | Only painful joints and adjacent and contralateral joints | Y | Y | Y | N | N | At patient level US abnormalities were not associated with arthritis development. |
| Pratt et al, 201344 | Main study on arthritis, 46 patients with new-onset inflammatory arthralgia (secondary care) | 379† | 162 (42) | NP | 28 (NP) | MCP, PIP and MTP joints, bilaterally | Y | Y | N | Y | N | The presence of MSUS abnormalities was not associated with development of persistent inflammatory arthritis in patients presenting with arthralgia, in the absence of clinical synovitis. |
| Rakieh et al, 201527 | ACPA+ persons with aspecific musculoskeletal symptoms (primary and secondary care) | 100 | 50 (50) | 7.9 (0.1–52) | 20 (0.1–69) | Wrist, MCP and PIP joints, bilaterally | N | Y | N | N | N | PD signal was not associated with arthritis development (HR 1.9, 95% CI 0.8 to 4.2, independent of tenderness of small joints, morning stiffness, RF and/or ACPA and SE). PPV of PD signal for development of arthritis: 67%. |
| Van der Ven et al, 201645 | Arthralgia in ≥2 joints in hands, feet or shoulders <1 year (secondary care) | 196‡ | 36 (23) | NP | NP (max 12 months) | Wrist, MCP, PIP and MTP joints, bilaterally | Y | Y | N | N | N | The presence of PD signal (OR 3.4, 95% CI 1.7 to 7.0) was associated with development of arthritis, independent of ACPA. |
| Nam et al, 201646 | ACPA+ persons with aspecific musculoskeletal symptoms (primary and secondary care) | 136 | 57 (42) | 8.6 (0.1–52) | 18 (0.1–80) | Wrist, MCP, PIP and MTP joints, bilaterally | Y | Y | N | Y | N | Both GS and PD associated with arthritis development: GS≥2 hour, 2.8 (0.4–20), PD=2 hours, 3.7 (2.0–6.9). PPV of GS≥2 for development of arthritis was 48% and of PD=2 75%. |
| Zufferey et al, 201735 | RF and ACPA polyarthralgia of >6 weeks duration (secondary care) | 80 | 9 (11) | NP | 18 (7)‡ | Wrist, MCP, PIP, elbow and knee joints, bilaterally | Y | N | N | N | N | US synovitis at baseline was associated with progression to RA. OR was 7.5 (95% CI 1.2 to 43) for SONAR >8/66 and 10 (95%CI 1.1 to 49) for grade ≥2 in ≥2 joints, independent of gender and CRP. PPV of US significant synovitis for development of arthritis: 25%. |
*Mean (SD).
†46/379 had a swollen joint count ≥1 at baseline. Outcome was persistent inflammatory arthritis.
‡Only 159 completed the 12 months’ follow-up. Studies depicted in grey have provided absolute risks.
ACPA, anticitrullinated protein antibodies; CRP, C reactive protein; GS, greyscale; MCP, metacarpophalangeal; MSUS, musculoskeletal ultrasound; MTP, metatarsophalangeal; N, no; NP, not provided; PD, power Doppler; PIP, proximal interphalangeal; PPV, positive predictive value; RA, rheumatoid arthritis; RF, rheumatoid factor; SE, shared epitope; SONAR, Swiss sonography in arthritis and rheumatism; US=ultrasound; Y, Yes.