Magnetic resonance imaging (MRI) and ultrasound predictors of progression to inflammatory arthritis in anti-cyclic citrullinated peptide (anti-CCP)–positive individuals with musculoskeletal symptoms without clinical synovitis: a prospective cohort study
Authors' conclusion
In this cohort of CCP+ at-risk undergoing contemporaneous ultrasound and MRI, MRI-detected hand tenosynovitis and ultrasound bone erosions independently predicted progression to IA. Their combination identified those at the highest risk, supporting complementary roles for both modalities.
Study context
- Population
- Anti-CCP-positive individuals with musculoskeletal symptoms without clinical synovitis (CCP+ at-risk)
- Participants
- 130 individuals
- Exposure
- MRI and ultrasound features as predictors of progression to inflammatory arthritis (IA)
- Outcome
- Progression to IA
Methodological detailsCox models with prespecified MRI and ultrasound parameterisations, contrast-enhanced 3 T MRI, 36-joint and 18-tendon ultrasound protocol
- Cox models with prespecified MRI and ultrasound parameterisations
- Contrast-enhanced 3 T MRI
- 36-joint and 18-tendon ultrasound protocol
Main finding
As reported in the abstract
median follow-up 36.5 months
Progressed to IA
48
36.9%
Composite of MRI tenosynovitis and US-detected erosions: additional increase in risk, highest with both features (HR)
5.83
Observational data: associations, not effects.
Further findings
Baseline imaging abnormalities
- US abnormalities detected
- 25.4%
- ≥1 Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) abnormality present in all CCP+ at-risk individuals (including US-negative)
Original publication
MRI and ultrasound predictors of progression to inflammatory arthritis in anti-CCP–positive individuals with musculoskeletal symptoms without clinical synovitis: a prospective cohort study. Ann Rheum Dis. Published 18 September 2026. doi:10.
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