Hand tenosynovitis on MRI plus erosions on ultrasound: a nearly sixfold risk of progressing to arthritis

The edition in brief

One hundred and thirty anti-CCP-positive individuals with musculoskeletal symptoms but no clinical synovitis had contrast-enhanced 3T MRI of the hand and both feet plus a 36-joint, 18-tendon ultrasound protocol. Every single one had at least one RAMRIS abnormality, including those whose ultrasound was normal; ultrasound abnormalities appeared in 25.4 per cent. Over a median 36.5 months, 48 of 130 (36.9 per cent) developed inflammatory arthritis. MRI hand tenosynovitis was the only MRI feature consistently predictive, ultrasound-detected bone erosions the most consistently predictive ultrasound feature, and having both carried a hazard ratio of 5.83. In polymyalgia rheumatica, contrast-enhanced orbital MRI found inflammatory intraorbital changes in 9 of 73 patients with isolated polymyalgia (12.3 per cent) — none of whom had any evidence of large-vessel vasculitis — and in 20 of 63 with combined giant cell arteritis and polymyalgia (31.7 per cent), most commonly bilateral optic nerve sheath enhancement. Ensemble clustering of 726 Japanese patients with newly diagnosed microscopic polyangiitis or granulomatosis with polyangiitis produced four reproducible phenotypes — renal-dominant without interstitial lung disease, renal-dominant with it, systemic multi-organ, and ENT-dominant — with differing survival and relapse, and a trend favouring rituximab over cyclophosphamide in the ENT-dominant group even in MPO-ANCA-positive patients. A systematic review of 49 studies found RSV vaccine effectiveness of 60 to 73 per cent in the first season in immunocompromised adults, with faster waning, no consistent autoimmune safety signal, and no data at all stratified by DMARD class.