Annals of the rheumatic diseases
September 18, 2026 · via Europe PMC
MRI and ultrasound predictors of progression to inflammatory arthritis in anti-CCP-positive individuals with musculoskeletal symptoms without clinical synovitis: a prospective cohort study.
Di Matteo A, Abacar K, Salaffi F, +12 more, Mankia K.
AI summary — for doctors, generated from the abstract only
In anti-CCP-positive individuals with joint symptoms but no clinical synovitis, MRI-detected hand tenosynovitis and ultrasound-detected bone erosions each independently predicted progression to inflammatory arthritis, and having both findings together identified the highest-risk group.
What was studied
A prospective cohort study of 130 anti-CCP-positive ('at-risk') individuals with musculoskeletal symptoms but no clinical synovitis underwent baseline contrast-enhanced MRI of the hand/feet and 36-joint/18-tendon ultrasound; imaging findings were compared using Cox models for their ability to predict progression to inflammatory arthritis (IA) over follow-up.
Key findings
- At baseline, at least one RAMRIS (MRI) abnormality was present in all participants, while ultrasound abnormalities were seen in 25.4%.
- Over a median follow-up of 36.5 months, 48 of 130 participants (36.9%) progressed to inflammatory arthritis.
- Hand tenosynovitis was the MRI feature consistently associated with progression; ultrasound-detected bone erosions were the most consistently predictive ultrasound feature.
- A composite of MRI tenosynovitis plus ultrasound erosions conferred the highest risk, with a hazard ratio of 5.83 in those with both features.
Clinical relevance
The findings suggest that combining hand MRI and ultrasound findings may help identify anti-CCP-positive at-risk individuals at highest risk of progressing to inflammatory arthritis, which could inform future risk-stratification approaches, though the abstract notes feasibility and cost-effectiveness of combining both modalities still need evaluation.
Who should care
Limitations
The abstract does not report statistical significance values (e.g., p-values or confidence intervals) for most individual associations beyond the composite hazard ratio, and the cohort was limited to 130 individuals at a single point in time with MRI of only the dominant/most symptomatic hand.
Combining MRI tenosynovitis and ultrasound bone erosion findings helped identify at-risk individuals most likely to progress to inflammatory arthritis.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
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).
Methods
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.
Results
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).
Conclusions
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.
DOI
10.1016/j.ard.2026.08.016
PMID
42760165
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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