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Cohort studyAnnals of the rheumatic diseases · 2026

Ultrasound-defined presynovitis is associated with progression to clinical arthritis in ACPA-positive individuals at risk of rheumatoid arthritis: longitudinal insights from the Karolinska Risk-RA cohort.

Yogan Kisten, Alexandra Cîrciumaru, Marina Dehara … Lars Klareskog

RheumatologyCohort study

Any ultrasound finding at baseline is associated with a higher risk of clinical arthritis.

Ultrasound-defined presynovitis is associated with progression to clinical arthritis in ACPA-positive individuals at risk of rheumatoid arthritis: longitudinal insights from the Karolinska Risk-RA cohort.

Yogan Kisten et al. · Annals of the rheumatic diseases · 2026

Purpose

This study aimed to investigate whether ultrasound (US)-detected features preceding Doppler-active synovitis are associated with progression to clinical arthritis in anticitrullinated protein antibody (ACPA)-positive individuals with musculoskeletal (MSK) symptoms.

Methods

In this prospective cohort study, 309 ACPA-positive individuals with MSK symptoms but without clinical arthritis and Doppler-active synovitis were included.

n = 309 participants

Results

any ultrasound finding at baseline means a 3-fold higher chance of developing arthritis

HR 3.30 (95% CI 2.30 to 4.80)

null 1

2.30

4.80

CI excludes the null - significant

More results

Among these, tendon sheath involvement showed the strongest association (HR 3.6, 95% CI 2.4-5.4), especially in combination with IgM RF positivity (HR 4.2, 95% CI 2.7-6.4).

Tendon involvement frequently preceded synovial changes.

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Conclusion

Minimal US findings preceding Doppler-active synovitis, particularly tendon involvement, were strongly associated with progression to clinical arthritis in ACPA-positive individuals and support an US-identified 'presynovitis' phase of rheumatoid arthritis development and early risk stratification.

Post

Ultrasound-defined presynovitis is associated with progression to clinical arthritis in ACPA-positive individuals at risk of rheumatoid arthritis: longitudinal insights from the Karolinska Risk-RA cohort.

Any ultrasound finding at baseline is associated with a higher risk of clinical arthritis.

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