Ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti-CCP positive at-risk individuals without clinical synovitis.

Abstract

OBJECTIVES:

To investigate, in anti-cyclic citrullinated peptide antibody positive (CCP+) at-risk individuals without clinical synovitis, the prevalence and distribution of ultrasound (US) bone erosions (BE), their correlation with subclinical synovitis and their association with the development of inflammatory arthritis (IA).

METHODS:

Baseline US scans of 419 CCP+ at-risk individuals were analysed. BE were evaluated in the classical sites for rheumatoid arthritis damage: the second and fifth metacarpophalangeal (MCP2 and MCP5) joints, and the fifth metatarsophalangeal (MTP5) joints. US synovitis was defined as synovial hypertrophy (SH) ≥2 or SH ≥1+power Doppler signal ≥1. Subjects with ≥1 follow-up visit were included in the progression analysis (n=400).

RESULTS:

BE were found in ≥1 joint in 41/419 subjects (9.8%), and in 55/2514 joints (2.2%). The prevalence of BE was significantly higher in the MTP5 joints than in the MCP joints (p<0.01). A significant correlation between BE and US synovitis in the MTP5 joints was detected (Cramer's V=0.37, p<0.01). The OR for the development of IA (ever) was highest for the following: BE in >1 joint 10.6 (95% CI 1.9 to 60.4, p<0.01) and BE and synovitis in ≥1 MTP5 joint 5.1 (95% CI 1.4 to 18.9, p=0.02). In high titre CCP+ at-risk individuals, with positive rheumatoid factor and BE in ≥1 joint, the OR increased to 16.9 (95% CI 2.1-132.8, p<0.01).

CONCLUSIONS:

In CCP+ at-risk individuals, BE in the feet appear to precede the onset of clinical synovitis. BE in >1 joint, and BE in combination with US synovitis in the MTP5 joints, are the most predictive for the development of clinical arthritis.

• Authors: Andrea Di Matteo, Kulveer Mankia, Laurence Duquenne, Edoardo Cipolletta, Richard J Wakefield, Leticia Garcia-Montoya, Jacqueline Leong Nam, Paul Emery
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 79 Issue 7 Pg. 901-907 (07 2020) ISSN: 1468-2060 [Electronic] England
• PMID: 32366522 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Anti-Citrullinated Protein Antibodies

Topics

• Adult
• Anti-Citrullinated Protein Antibodies (blood)
• Arthritis, Rheumatoid (blood, complications, diagnostic imaging)
• Bone Diseases (diagnostic imaging, etiology)
• Disease Progression
• Female
• Foot Bones (diagnostic imaging, physiopathology)
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Risk Assessment
• Risk Factors
• Ultrasonography