Predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis

Peter P Cheung, Karine Mari, Valérie Devauchelle-Pensec, Sandrine Jousse-Joulin, Maria Antonietta D'Agostino, Gérard Chalès, Philippe Gaudin, Xavier Mariette, Alain Saraux, Maxime Dougados, Peter P Cheung, Karine Mari, Valérie Devauchelle-Pensec, Sandrine Jousse-Joulin, Maria Antonietta D'Agostino, Gérard Chalès, Philippe Gaudin, Xavier Mariette, Alain Saraux, Maxime Dougados

Abstract

Objective: To evaluate the predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis (RA).

Methods: A post hoc analysis was performed on a prospective 2-year study of 59 patients with active RA starting on antitumour necrosis factor (TNF). Tenderness and synovitis was assessed clinically at baseline, followed by blinded ultrasound assessment (B-mode and power Doppler ultrasound (PDUS)) on the hands and feet (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal and 10 metatarsophalangeal (MTP) joints). Radiographs of these joints were performed at baseline and at 2 years. The risk of radiographic progression with respect to the presence of baseline tenderness or synovitis, as well as its persistence (after 4 months of anti-TNF), was estimated by OR (95% CI).

Results: Baseline tender joints were the least predictive for radiographic progression (OR=1.53 (95% CI 1.02 to 2.29) p<0.04), when compared to synovitis (clinical OR=2.08 (95% CI 1.39 to 3.11) p<0.001 or PDUS OR=1.80 (95% CI 1.20 to 2.71) p=0.005, respectively). Tender joints with the presence of synovitis were predictive of radiographic progression (OR=1.89 (95% CI 1.25 to 2.85) p=0.002), especially seen in the MTP joints. Non-tender joints with no synovitis were negatively predictive (OR=0.57 (95% CI 0.39 to 0.82) p=0.003). Persistence of tender joints was negatively predictive (OR=0.38 (95% CI 0.18 to 0.78) p=0.009) while persistence of synovitis was predictive (OR=2.41 (95% CI 1.24 to 4.67) p=0.01) of radiographic progression.

Conclusions: Synovitis is better than tenderness to predict for subsequent structural progression. However, coexistence of tenderness and synovitis at the level of an individual joint is predictive of structural damage, particularly in the MTP joints.

Trial registration number: NCT00444691.

Keywords: Disease Activity; Outcomes research; Rheumatoid Arthritis; Synovitis; Ultrasonography.

Figures

Figure 1
Figure 1
Ability of baseline tenderness to predict for radiographic progression at 2 years compared to synovitis.
Figure 2
Figure 2
Ability of tenderness and clinical synovitis assessed together, to predict for radiographic progression at 2 years.
Figure 3
Figure 3
Ability of baseline tenderness and various synovitis definitions (both clinical and ultrasound), assessed together to predict for radiographic progression at 2 years.

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