Table 4

Articles reporting imaging findings alone as risk factors in individuals at risk of RA

StudyPopulationCohort sizeRisk factorFrequencyOutcome
Ultrasound alone
MSK symptoms without arthritis
van de Stadt et al36Seropositive arthralgia (ACPA and/or RF)192US PD signal (joint level)BLDevelopment of IA
OR=2.9 (95% CI 4.65 to 360)
Nam et al33Anti-CCP+ with non-specific MSK symptoms136US PD signal (patient level)
US BE (patient level)
USGS ≥2 (patient level)
BLDevelopment of IA
US PD signal: HR 3.7 (95% CI 2.0 to 6.9), p<0.001
US BE: HR 2.9 (95% CI 1.7 to 5.1), p<0.001
US GS ≥2: HR 2.3 (95% CI 1.0 to 4.9), p=0.038
Zufferey et al40Anti-CCP-negative patients with arthralgia and no synovitis80US synovitis (SONAR score)BLProgression to RA
OR=7.4 (95% CI 1.19 to 42.8), p=0.02
van Beers-Tas et al37Seropositive arthralgia (ACPA and/or RF)163US GS ≥2 (excluding MTP joints)
(patient level)
BLDevelopment of IA
HR=3.4 (95% CI 1.6 to 6.8), p<0.01
Pentony et al34Anti-CCP+ with non-specific MSK symptoms44US total PD score in the wrists, MCPJs (1–5) and PIP joints (1–5)BL
Development of IA
54.5% progressors had increased PD signal score longitudinally vs 9.1% non-progressors
Kisten et al38Anti-CCP+ with non-specific MSK symptoms but no clinical/US inflammation66US TSV (patient level)BL or FU visitsDevelopment of IA
RR=3.0 (95% CI 1.8 to 4.8), p=0.001
Hensvold et al39Anti-CCP+ with non-specific MSK symptoms but no clinical/US inflammation66Combined US-TSV on US (patient level) and positive HLA-SEBLDevelopment of IA
HR=4.9 (95% CI 1.5 to 16), p=0.01
Duquenne et al35Anti-CCP+ with non-specific MSK symptoms307≥1 joint with PD signal>12M before progression
3–12M before progression
<3M before progression
Development of IA in the next 3 months
Early clinical arthritis
Freeston et al41UA ≤12W of inflammatory arthralgia ±synovitis50US GS score ≥3, PD signal ≥1, ≥1 BEBLDevelopment of persistent arthritis
Probability increased from 34% to 94%
Filer et al42UA—early synovitis of ≥1 joint and symptom duration ≤3M58PD 10 index: summed PD grades of MCP joints 2–3, wrists and MTP joints 2–3BLDevelopment of RA
PD 10 index combined with Leiden prediction score: AUC 0.962, compared with AUC 0.905 (Leiden score alone), p<0.05
Sahbudin et al43UA—early synovitis of ≥1 joint and symptom duration ≤3M107US digital flexor TSV
Positive PD signal in MCP3
BLDevelopment of RA
OR=4.066 (95% CI 1.444 to 11.444), p=0.008
OR=3.078 (95% CI 1.047 to 9.046), p=0.041
MSK symptoms without arthritis
Kleyer et al44ACPA-positive at-risk individuals20MRI TSV at ≥2 sitesBLDevelopment of RA
5/5 (100%) of individuals who developed RA had MRI TSV at ≥2 sites
Van Steenbergen et al46CSA150Subclinical MRI inflammationBLDevelopment of IA
HR=5.07 (95% CI 1.77 to 14.50), p=0.002
Boer et al63Patients with CSA and patients with UA (arthritis <2 years)225 CSA+201 UAMRI inflammation
‘corrected’ for MRI abnormalities in healthy individuals
BL‘Corrected’ versus ‘uncorrected’ MRI inflammation
Development of IA at 12 months
Accuracy 60% (95% CI 54 to 67) vs 32% (95% CI 26–38)
AUC 0.71 vs 0.55
Fulfilment of 1987 RA criteria at 12 months
Accuracy 44% (95% CI 38 to 51) vs 22% (95% CI 17 to 29)
AUC 0.65 vs 0.52
Hunt et al45Anti-CCP+ individuals with non-specific MSK symptoms98MRI TSV
US PD+ ≥2
US GS ≥2
BLDevelopment of IA
HR=4.02 (95% CI 1.91 to 8.44), p=0.002
HR=5.09 (95% CI 1.93 to 13.44), p=0.006
HR=2.69 (95% CI 1.14 to 6.34), p=0.059
Early clinical arthritis
Navalho et al49Untreated recent onset (<1 year) polyarthritis32MRI ECU TSV
MRI synovitis of the radioulnar joint
BLDevelopment of RA
OR=3.21 (95% CI 1.09 to 9.40), p=0.03
OR=9.6 (95% CI 1.17 to 78.93), p=0.03
OR=8.79 (95% CI 1.02 to 75.63), p=0.04
Navalho et al47Untreated recent onset (<1 year) undifferentiated polyarthritis4MRI carpal joint synovitis
MRI flexor tendon TSV
MRI global joint and tendon count
Global MRI and US scores
BLDevelopment of RA
OR=3.64 (95% CI 1.19 to 11.84), p=0.032
OR=5.09 (95% CI 1.62 to 16.05), p=0.005
OR=2.77 (95% CI 1.249 to 6.139), p=0.012
AUC=0.959 and=0.853, respectively, p<0.05
Dakkak et al48UA (arthritis in ≥1 joint, symptom duration <2 years)123MRI TSV in feet adjusted for BME and synovitis of the foot
MRI TSV in feet adjusted for CRP and swollen joint count
MRI TSV in hands independent of BME and synovitis
BLDevelopment of RA
OR=3.29 (95% CI 1.03 to 10.53)
OR=2.14 (95% CI 0.77 to 5.95)
OR=3.99 (95% CI 1.64 to 9.69)
  • HR/OR and CIs have been reported where available.

  • +, positive; A, abstract only; ACPA, anticyclic citrullinated peptide antibodies; AUC, area under the curve; BE, bone erosions; BL, baseline; BME, bone marrow oedema; CCP, cyclic citrullinated peptide; CRP, C reactive protein; CSA, clinically suspect arthralgia; ECU, extensor carpi ulnaris; FDRs, first-degree relatives; FT, flexor tendons; FU, follow-up; GS, grey scale; IA, inflammatory arthritis; M, months; MCPs, metacarpophalangeal joints; MSK, musculoskeletal; MSUS, musculoskeletal ultrasound; MTPs, metatarsophalangeal joints; PD, power Doppler; PPV, positive predictive value; RA, rheumatoid arthritis; RF, rheumatoid factor; RR, relative risk; TSV, tenosynovitis; UA, unclassified/undifferentiated arthritis; US, ultrasound; W, weeks.