In anti-CCP-positive people with symptoms, MRI tenosynovitis and ultrasound erosions predicted arthritis

Design

Prospective cohort with contemporaneous MRI and ultrasound, Cox models

Population

130 anti-CCP-positive people with musculoskeletal symptoms without clinical synovitis

Primary outcome

Progression to inflammatory arthritis

Effect

36.9% progressed over a median of 36.5 months; combined MRI tenosynovitis and ultrasound erosions HR 5.83

This prospective cohort enrolled 130 anti-CCP-positive people with musculoskeletal symptoms but no clinical synovitis. Each had contrast-enhanced 3 T MRI of the hand and feet and a detailed ultrasound at baseline.

At least one MRI abnormality was found in all, including those with negative ultrasound, whereas ultrasound abnormalities were found in 25.4%. Over a median of 36.5 months, 48 (36.9%) progressed to inflammatory arthritis. Hand tenosynovitis on MRI was the only MRI feature consistently linked to progression, and ultrasound bone erosions were the most consistent ultrasound predictor. Having both gave the highest risk (hazard ratio 5.83).

The authors say the feasibility and cost-effectiveness of using both modalities need evaluating. For now, this helps identify who among at-risk patients deserves closer follow-up, not whom to treat.

• Follow anti-CCP-positive patients with symptoms closely, since about 37% progressed within three years in this cohort.
• Ask for tenosynovitis on any hand imaging performed in these patients.
• Consider ultrasound for erosions as a relatively accessible way of refining risk.
• Do not start disease-modifying treatment on imaging findings alone outside a trial or local pathway.
• Remember that nearly all participants had some MRI abnormality, so MRI findings must be interpreted by feature.

Why it matters

Risk stratification in arthralgia could target prevention to the people most likely to benefit.

Don't overread it

A single prospective cohort of 130 at-risk people from specialist services; it does not show that imaging-guided treatment prevents arthritis.

The statistics, in plain English

A hazard ratio of 5.83 means the rate of progression was almost six times higher when both features were present, compared with neither. The cohort was small, so the interval around that figure would be wide, and the composite was one of several tested.

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