title: Predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis.
abstract: OBJECTIVE
  To evaluate the predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis (RA).
  
  
  METHODS
  A post hoc analysis was performed on a prospective 2-year study of 59 patients with active RA starting on antitumour necrosis factor (TNF). Tenderness and synovitis was assessed clinically at baseline, followed by blinded ultrasound assessment (B-mode and power Doppler ultrasound (PDUS)) on the hands and feet (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal and 10 metatarsophalangeal (MTP) joints). Radiographs of these joints were performed at baseline and at 2 years. The risk of radiographic progression with respect to the presence of baseline tenderness or synovitis, as well as its persistence (after 4 months of anti-TNF), was estimated by OR (95% CI).
  
  
  RESULTS
  Baseline tender joints were the least predictive for radiographic progression (OR=1.53 (95% CI 1.02 to 2.29) p<0.04), when compared to synovitis (clinical OR=2.08 (95% CI 1.39 to 3.11) p<0.001 or PDUS OR=1.80 (95% CI 1.20 to 2.71) p=0.005, respectively). Tender joints with the presence of synovitis were predictive of radiographic progression (OR=1.89 (95% CI 1.25 to 2.85) p=0.002), especially seen in the MTP joints. Non-tender joints with no synovitis were negatively predictive (OR=0.57 (95% CI 0.39 to 0.82) p=0.003). Persistence of tender joints was negatively predictive (OR=0.38 (95% CI 0.18 to 0.78) p=0.009) while persistence of synovitis was predictive (OR=2.41 (95% CI 1.24 to 4.67) p=0.01) of radiographic progression.
  
  
  CONCLUSIONS
  Synovitis is better than tenderness to predict for subsequent structural progression. However, coexistence of tenderness and synovitis at the level of an individual joint is predictive of structural damage, particularly in the MTP joints.
  
  
  BACKGROUND
  NCT00444691.
authors.affiliation: Division of Rheumatology , National University Hospital , Singapore , Singapore.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Cheung
authors.affiliation: RCTs , Lyon , France.
authors.forename: Karine
authors.initials: K
authors.lastname: Mari
authors.affiliation: Department of Rheumatology, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France; EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Devauchelle-Pensec
authors.affiliation: Department of Rheumatology, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France; EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.affiliation: Department of Rheumatology , APHP, Ambrose-Paré, Versailles-Saint Quentin en Yvelines University , Boulogne-Billancourt , France.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: D'Agostino
authors.affiliation: Department of Rheumatology , Hôpital Sud, CHU Rennes , Rennes , France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Chalès
authors.affiliation: Department of Rheumatology , University Hospital, Grenoble, Hôpital Sud , Echirolles , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.affiliation: Department of Rheumatology , Hôpitaux Universitaires Paris-Sud; Université Paris-Sud; INSERM U1012; Le Kremlin Bicêtre , Paris , France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.affiliation: Department of Rheumatology, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France; EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.affiliation: Department of Rheumatology , Hôpital Cochin , Paris , France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
keywords: Disease Activity; Outcomes research; Rheumatoid Arthritis; Synovitis; Ultrasonography