Synovial fibroblast activation occurs before the onset of rheumatoid arthritis and influences the risk of developing disease
Authors' conclusion
The findings in this small RA-at-risk cohort suggest that synovial fibroblast activation occurs early in the disease process of RA and is associated with an increased risk for clinical RA onset.
Study context
- Population
- ACPA-positive individuals with clinically suspect arthralgia, without present or past joint swelling or anti-rheumatic therapymale/female: 7/11
- Participants
- 18 individuals
- Outcome
- RA development in relation to synovial fibroblast activation protein inhibitor (FAPI) uptake
Methodological details68Ga-FAPI-46 positron emission tomography-CT (PET-CT) imaging
- 68Ga-FAPI-46 PET-CT imaging
Main finding
As reported in the abstract
TL-FAPI as predictor of RA development
HR (TL-FAPI, predictor of rheumatoid arthritis (RA) development), 95% CI 1.38 to 15.22, p=0.013
4.58
Observational data: associations, not effects.
Further findings
RA development (incidence)
- Developed RA (28%), median time 12 weeks (IQR 11-20); 13 remained disease-free
- 5
Joint-level TL-FAPI and tenderness
- Risk ratio per increasing TL-FAPI, 95% CI 1.08 to 1.22, p=0.001
- 1.14
Original publication
Synovial fibroblast activation occurs before the onset of rheumatoid arthritis and influences the risk of developing disease. RMD Open. Published 27 November 2025. doi:10.
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