MRI and ultrasound predictors of progression to inflammatory arthritis in anti-CCP-positive individuals with musculoskeletal symptoms without clinical synovitis: a prospective cohort study.

Authors

Andrea Di Matteo, Kerem Abacar, Fausto Salaffi, Sonia Farah, Marina Carotti, Didem Sahin, Sana Sharrack, Kate Harnden, Helen Sugden, Kate Smith, Laurence Duquenne, Leticia Garcia-Montoya, Richard J Wakefield, Jacqueline Nam, Paul Emery, Kulveer Mankia

Published in

Annals of the rheumatic diseases. Sep 18, 2026. Epub Sep 18, 2026.

Abstract

This study aims to evaluate the prevalence of magnetic resonance imaging (MRI) and ultrasound features in anti-cyclic citrullinated peptide (anti-CCP) positive individuals with musculoskeletal symptoms without clinical synovitis (CCP+ at-risk), and compare their prognostic value for progression to inflammatory arthritis (IA).
Overall, 130 CCP+ at-risk underwent baseline contrast-enhanced 3 T MRI of the dominant/most symptomatic hand and both feet. Images were scored for synovitis, tenosynovitis, osteitis, and erosions using Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) by a rheumatologist and a radiologist. Ultrasound used a 36-joint and 18-tendon protocol for the assessment of synovitis, tenosynovitis, and bone erosions. Associations between imaging findings, clinical variables, and progression to IA were assessed using Cox models with prespecified MRI (binary and continuous score) and ultrasound (individual lesions and overall positivity) parameterisations.
At baseline, ≥1 RAMRIS abnormality was present in all CCP+ at-risk individuals (including ultrasound-negative individuals), while ultrasound abnormalities were detected in 25.4%. Over a median follow-up of 36.5 months, 48 (36.9%) progressed to IA. Hand tenosynovitis was the only MRI feature consistently associated with progression across binary and continuous analyses. Ultrasound-detected bone erosions were the most consistently predictive ultrasound feature. A composite of MRI tenosynovitis and ultrasound-detected erosions showed an additional increase in risk, highest in individuals with both features (hazard ratio 5.83).
In this cohort of CCP+ at-risk undergoing contemporaneous ultrasound and MRI, MRI-detected hand tenosynovitis and ultrasound bone erosions independently predicted progression to IA. Their combination identified those at the highest risk, supporting complementary roles for both modalities. The feasibility and cost-effectiveness of combined hand MRI and extensive ultrasound require evaluation.

PMID:
42760165
Bibliographic data and abstract were imported from PubMed on 19 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.