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Joint Tissue Inflammation Sequence in RA Development

Arthritis Res Ther; ePub 2018 Nov 21; ten Brinck, et al

Increased tenosynovitis and synovitis scores at clinically suspect arthralgia (CSA) onset and the increase in synovitis and osteitis during progression to rheumatoid arthritis (RA) suggest an “outside-in” temporal relationship of arthritis development, in particular for anti-citrullinated protein antibody (ACPA)-negative RA. This according to a longitudinal study that assessed the course of MRI-detected subclinical joint inflammation during progression to RA. Patients that progressed from CSA to RA underwent 1.5-T MRI of the metacarpophalangeal (MCP), wrist, and metatarsophalangeal (MTP) joints at presentation with arthralgia and at first identification of synovitis assessed through physical examination (n=31). MRIs were evaluated for osteitis, synovitis, tenosynovitis, and erosions by 2 readers, blinded for clinical data and order in time. Researchers found:

  • At presentation with CSA, synovitis and tenosynovitis scores were higher than scores from age-matched symptom-free persons.
  • ACPA-positive arthralgia patients also had increased osteitis scores.
  • Median duration between presentation with arthralgia and RA development was 17 weeks.
  • During progression to RA, synovitis and osteitis increased significantly in contrast to tenosynovitis and erosion scores.


ten Brinck RM, van Steenbergen HW, van der Helm-van Mil AHM. Sequence of joint tissue inflammation during rheumatoid arthritis development. [Published online ahead of print November 21, 2018]. Arthritis Res Ther. doi:10.1186/s13075-018-1756-z.