title: High prevalence of tenosynovial inflammation before onset of rheumatoid arthritis and its link to progression to RA-A combined MRI/CT study.
abstract: To define the anatomic distribution of the earliest inflammatory and structural changes in individuals with anti-citrullinated protein antibody (ACPA+) positivity but no signs of arthritis.
  
  
  
  ACPA+ individuals (N = 20) and healthy controls (N = 13) received simultaneous gadolinium-enhanced magnetic resonance imaging (MRI) and high-resolution peripheral quantitative computed tomography (HR-pQCT) of the hands. MRI sequences were scored for synovitis, osteitis, and bone erosions according to the RAMRIS method as well as for presence, localization, and extent of tenosynovitis. Bone erosions were validated by HR-pQCT scanning and related to the inflammatory changes found in the MRI.
  
  
  
  Tenosynovitis was the most prevalent inflammatory pathology, affecting 80% of ACPA+ individuals but none of the controls. Tenosynovitis at two or more anatomical sites was associated with later development of RA. Synovitis (65%) and osteitis (35%) were present in ACPA+ individuals as well, but at a lower frequency than tenosynovitis. MRI bone erosions were found in 65% of the individuals and additionally confirmed by HR-pQCT. Presence of MRI osteitis was the inflammatory pathology most strongly associated with bone erosions.
  
  
  
  Tenosynovitis is highly prevalent in ACPA+ individuals without arthritis and associated with later development of RA. Small erosions, often linked to osteitis, are also found in ACPA+ individuals without arthritis.
authors.affiliation: Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany.
authors.forename: Arnd
authors.initials: A
authors.lastname: Kleyer
authors.affiliation: Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Krieter
authors.affiliation: Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Oliveira
authors.affiliation: Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany.
authors.forename: Francesca
authors.initials: F
authors.lastname: Faustini
authors.affiliation: Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Simon
authors.affiliation: Institute of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Maximilansplatz 1, D-91054 Erlangen, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Kaemmerer
authors.affiliation: CSD Clinica Som Diagnosticos, Parque Shopping Belém, Belém, PA, 66635-110, Brasil.
authors.forename: Alan
authors.initials: A
authors.lastname: Cavalcante
authors.affiliation: CSD Clinica Som Diagnosticos, Parque Shopping Belém, Belém, PA, 66635-110, Brasil.
authors.forename: Taiane
authors.initials: T
authors.lastname: Tabosa
authors.affiliation: Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Rech
authors.affiliation: Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Hueber
authors.affiliation: Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany. Electronic address: georg.schett@uk-erlangen.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Schett
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008983:Molybdoferredoxin; D064847:Multimodal Imaging; D012720:Severity of Illness Index; D013717:Tenosynovitis / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D008983:Molybdoferredoxin
keywords: ACPA; CT; Imaging; MRI; Tenosynovitis; pre-RA