Higher Baseline and Grayscale Ultrasound Synovitis Do Not Indicate Worse RA Prognosis


While subclinical synovitis is a common problem in the prognosis of RA, it is difficult to detect it by imaging methods and leads to joint destruction in some patients.

Both baseline synovitis and higher grayscale ultrasound (GSUS) synovitis is not indicative of a worse rheumatoid arthritis (RA) prognosis, according to a study published in Springer.1 Regular musculoskeletal ultrasound (MSUS) synovitis follow-ups may have a positive influence on treatment.

“In the past years, the ‘treat to target’ (T2T) strategy aimed at clinical remission has routinely been implemented in clinical practice, and consequently, the prognosis of RA has been greatly improved,” investigators stated. “However, joint destruction continues to occur on some patients because of the worse radiographic progression. Subclinical synovitis is a common problem in the prognosis of RA, but because of the current stagnation of imaging, it is difficult to detect it by imaging methods, which leads to joint destruction in some patients.”

An analysis of 138 patients, ranging from 18 to 75 years (85.5% female with a mean age of 44.9 years), with RA was performed with an emphasis on a patient’s first MSUS record at baseline. There were 55.1% (n = 76) in the alleviation group and 44.9% (n = 62 in the progression group. Approximately half (51.3%) of patients in the alleviation group achieved partial remission.

A total of 115 patients were RF-positive and 113 were anti-CCP antibody-positive. Changes in MSUS, showing alleviation or progression, were compared. GSUS synovitis, MSUS synovitis, power Doppler ultrasound (PDUS) synovitis, PDUS tenosynovitis (TS), and any b0ne erosion were evaluated and scored via a semi-quantitative scale.

Results were divided into alleviation and progression cohorts. Groups were then compared using laboratory results, including anticyclic citrullinated peptide (anti-CCP) antibody, anti-keratin antibody (AKA), erythrocyte sedimentation rate (ESR), disease activity score in 28 joints (DAS28)-ESR, C-reactive protein (CRP), and rheumatoid factor (RF) to determine the prognostic value of US results in RA.

The alleviation cohort had higher CRP, synovitis, TS, GSUS and PDUS synovitis, PDUS TS, and US scores at baseline when compared with patients in the progression cohort. Those in the alleviation group had more aggressive treatment initially when compared with the progression cohort. Baseline synovitis and higher GSUS synovitis scores were associated with RA progression.

“Our results indicate that RA patients should undergo US assessment not only at baseline but also in the follow-up. US manifestations should be interpreted with great cautions because synovitis and higher GSUS synovitis score at baseline do not always mean worse prognosis,” investigators concluded. “All of these may be reversed by aggressive treatment leading to better prognosis. It is easy to overlook the patients with mild synovitis and low GSUS synovitis, who receive routine treatment and without ultrasonic reexamination may result in bad prognosis.”


Sun C, Qi X, Yang Y, Lei L, Gao L, Guo H. Importance of baseline musculoskeletal ultrasound findings in the prognosis of rheumatoid arthritis [published online ahead of print, 2022 Jan 18] [published correction appears in Clin Rheumatol. 2022 Jan 28;:]. Clin Rheumatol. 2022;10.1007/s10067-021-06017-7. doi:10.1007/s10067-021-06017-7

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