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Development of clinically apparent synovitis: a longitudinal study at the joint level during progression to
Robin M Ten Brinck1, Hanna W van Steenbergen1, Annette H M van der Helm-van Mil1,2
1Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
Introduction:
Subclinical inflammation, detected by MRI, in patients with arthralgia is predictive for development of inflammatory arthritis (IA). However, within patients that develop IA, the course of inflammation at the joint level during this transition is unknown. This longitudinal study assessed progression of inflammation at the joint level.
Methods:
350 joints (unilateral metacarpophalangeals (MCPs), wrist, metatarsophalangeal (MTP) joints) of 35 patients presenting with clinically suspect arthralgia (CSA) that progressed to IA were studied at presentation with CSA and subsequently when clinical synovitis was first identified at joint examination (median time interval 17 weeks). At both time points, subclinical inflammation (bone marrow oedema, synovitis, tenosynovitis) was evaluated with MRI and joint examination was performed.
Results:
At presentation with CSA, 71 joints showed subclinical inflammation. During progression to IA, 20% of these joints had resolution of inflammation, 60% had persistent inflammation and 20% progressed to clinical synovitis. Of all joints that had developed clinical synovitis (n = 45), no prior subclinical inflammation was detected in 69%. Similar results were observed for anticitrullinated protein antibodies (ACPA)-positive and ACPA-negative patients.
Conclusions:
This longitudinal study demonstrated moderate correlations between joints with subclinical inflammation and joints that developed clinical synovitis. These data imply that IA development is a more systemic rather than a locally outgrowing process.
Insights
Inflammation in joints with early symptoms of inflammatory arthritis (IA) often resolves or persists, rather than directly progressing to clinical synovitis. This suggests IA development is a systemic process, not solely a local joint issue.
Area of Science:
- Rheumatology
- Medical Imaging
- Inflammatory Arthritis Research
Background:
- Subclinical inflammation on MRI in arthralgia patients predicts inflammatory arthritis (IA) development.
- The joint-level inflammatory course during the transition from arthralgia to IA remains unclear.
- Understanding this progression is crucial for early diagnosis and intervention in IA.
Purpose of the Study:
- To longitudinally assess the progression of inflammation at the joint level in patients transitioning from clinically suspect arthralgia (CSA) to IA.
- To determine the relationship between subclinical inflammation detected by MRI and the subsequent development of clinical synovitis.
- To investigate if IA development is a local or systemic process.
Main Methods:
- A longitudinal study involving 35 patients with CSA who progressed to IA.
- MRI and clinical joint examinations were performed at CSA presentation and upon identification of clinical synovitis (median 17 weeks interval).
- Evaluated subclinical inflammation (bone marrow edema, synovitis, tenosynovitis) in 350 joints (MCPs, wrists, MTPs).
Main Results:
- At CSA presentation, 71 joints had subclinical inflammation; 20% resolved, 60% persisted, and 20% progressed to clinical synovitis.
- Of joints developing clinical synovitis (n=45), 69% showed no prior subclinical inflammation.
- Similar patterns were observed in both anticitrullinated protein antibodies (ACPA)-positive and -negative patients.
Conclusions:
- Moderate correlation exists between joints with initial subclinical inflammation and those developing clinical synovitis.
- The findings suggest that inflammatory arthritis development is predominantly a systemic process.
- This implies that therapeutic strategies may need to consider systemic factors beyond localized joint inflammation.
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