ArticleRheumatology (Oxford, England)2021
Subclinical synovitis in arthralgia: how often does it result in clinical arthritis? Reflecting on starting points for disease-modifying anti-rheumatic drug treatment.
Article in Rheumatology (Oxford, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 22 citations in OpenAlex.
- Imaging tests as predictors of progression to rheumatoid arthritis in clinically suspect arthralgia: a systematic review and meta-analysis.Rheumatology (Oxford, England) · 2025Pooled it
- An ultrasound negative for subclinical synovitis in arthralgia patients: is it helpful in identifying those not developing arthritis?Rheumatology (Oxford, England) · 2022Pooled it
- Characterising subgroups of difficult-to-treat rheumatoid arthritis in real-world clinical settings.EULAR rheumatology open · 2026Article
- Ultrasound of the forefeet besides the hands in patients at risk for rheumatoid arthritis: is it worth the effort? A longitudinal cohort study.Rheumatology (Oxford, England) · 2025Article
- Ultrasound in anti-CCP+ at-risk individuals without clinical synovitis: development of a novel 6-joint protocol for feasible risk prediction.Rheumatology (Oxford, England) · 2024Article
- Factors associated with subclinical inflammation of wrist joints in rheumatoid arthritis patients with low or no disease activity- a RA ultrasound registry study.BMC musculoskeletal disorders · 2023Article
- Sequential ultrasound in arthralgia patients at risk for inflammatory arthritis: is it of added value in risk stratification?Scandinavian journal of rheumatology · 2023Article
- Ultrasound subclinical synovitis in anti-CCP-positive at-risk individuals with musculoskeletal symptoms: an important and predictable stage in the rheumatoid arthritis continuum.Rheumatology (Oxford, England) · 2022Article
- When and how should we use imaging in individuals at risk of rheumatoid arthritis?Frontiers in medicine · 2022Review
- Ultrasound in clinically suspect arthralgia: the role of power Doppler to predict rheumatoid arthritis development.Arthritis research & therapy · 2021Article
- What Is the Value of Ultrasound in Individuals 'At-Risk' of Rheumatoid Arthritis Who Do Not Have Clinical Synovitis?Healthcare (Basel, Switzerland) · 2021Review
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesAccording to guidelines, clinical arthritis is mandatory for diagnosing RA. However, in the absence of clinical synovitis, imaging-detected subclinical synovitis is increasingly used instead and is considered as a starting point for DMARD therapy. To search for evidence we studied the natural course of arthralgia patients with subclinical synovitis from three longitudinal cohorts and determined the frequencies of non-progression to clinically apparent inflammatory arthritis (IA) (i.e. 'false positives').
methodsSubclinical synovitis in the hands or feet of arthralgia patients was visualized with US (two cohorts; definition: greyscale ≥2 and/or power Doppler ≥1) or MRI (one cohort; definition: synovitis score ≥1 by two readers). Patients were followed for 1 year on for IA development; two cohorts also had 3 year data. Analyses were stratified for ACPA.
resultsSubclinical synovitis at presentation was present in 36%, 41% and 31% in the three cohorts. Of the ACPA-positive arthralgia patients with subclinical synovitis, 54%, 44% and 68%, respectively, did not develop IA. These percentages were even higher in the ACPA-negative arthralgia patients: 66%, 85% and 89%, respectively. Similar results were seen after 3 years of follow-up.
conclusionReplacing clinical arthritis with subclinical synovitis to identify RA introduces a high false-positive rate (44-89%). These data suggest an overestimation regarding the value of ACPA positivity in combination with the presence of subclinical synovitis in patients with arthralgia, which harbours the risk of overtreatment if DMARDs are initiated in the absence of clinical arthritis.
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