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The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound
  1. Maxime Dougados1,
  2. Valérie Devauchelle-Pensec2,
  3. Jean françois Ferlet3,
  4. sandrine Jousse-Joulin2,
  5. Maria-Antonietta D'Agostino4,
  6. Marina Backhaus5,
  7. Jacques Bentin6,
  8. Gérard Chalès7,
  9. Isabelle Chary-Valckenaere8,
  10. Philip Conaghan9,
  11. Richard J Wakefield10,
  12. Frédéric Etcheparre11,
  13. Philippe Gaudin12,
  14. Walter Grassi13,
  15. Désirée van der Heijde14,
  16. Xavier Mariette15,
  17. Esperanza Naredo16,
  18. Marcin Szkudlarek17
  1. 1Department of Rheumatology, Hopital Cochin, Paris, France
  2. 2Department of Rheumatologie, CHU Brest, Brest, France
  3. 3RCTs, Lyon, France
  4. 4Rheumatology Department, APHP, Ambroise-Paré Hospital, Versailles-Saint Quentin en Yvelines University, Boulogne-Billancourt, France
  5. 5Department of Rheumatology and Clinical Immunology, Universital Hospital Charit, Berlin, Germany
  6. 6Department of Medicine, CHU Brugmann, Bruxelles, Belgium
  7. 7Department of Rheumatology, Hôpital Sud, CHU Rennes, Rennes, France
  8. 8Department of Rheumatology, Vandoeuvre les Nancy, Meurthe et Moselle, France
  9. 9Section of Musculoskeletal Disease, University of Leeds, Leeds, UK
  10. 10Section of Musculoskeletal Disease, Leeds Institute of Musculoskeletal Disease LIMM, University of Leeds, Leeds, UK
  11. 11AP-HP, La Pitié-Salpétrière Hospital, Rheumatology Department, Paris-VI University, Paris, France
  12. 12Department of Rheumatology, University Hospital, Grenoble, Hôpital Sud, Echirolles, France
  13. 13Cattedra di Reumatologia, Università Politecnica delle Marche, Ancona, Italy
  14. 14Medical Center, Leiden University, Leiden, The Netherlands
  15. 15Department of Rheumatology, Le Kremlin Bicêtre, Paris, France
  16. 16Department of Rheumatology, Severo Ochoa Hospital, Madrid, Spain
  17. 17Department of Rheumatology, Hvidovre University Hospital, Hvidovre, Denmark
  1. Correspondence to Maxime Dougados, Hopital Cochin, Rheumatology, Clinique de Rhumatologie B, Groupe Hospitalier Cochin, Paris 75014, France; m.doug{at}


Objectives To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA).

Methods Patients with RA.

Study design Prospective, 2-year follow-up.

Data collected Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2.

Analysis Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis.

Results Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR=2.01 (1.36–2.98) p<0.001 versus 1.61 (1.06–2.45) p=0.026 versus 1.75 (1.18–2.58) p=0.005 for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of synovitis for the other modality was also observed (OR=2.16 (1.16–4.02) p=0.015 and 3.50 (1.77–6.95) p<0.001 for US-GS and US-PD and 2.79 (1.35–5.76) p=0.002) for clinical examination. Persistent (vs disappearance) synovitis after 4 months of therapy was also predictive of subsequent structural progression.

Conclusions This study confirms the validity of synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Funding This study was supported by an unrestricted grant from ABBOTT, France.

  • Competing interests

  • Patient Consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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    BMJ Publishing Group Ltd and European League Against Rheumatism