Ultrasound-defined presynovitis is associated with progression to clinical arthritis in ACPA-positive…

Cohort studyAnnals of the rheumatic diseases· Jul 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 studyPrognosisQ1IF 11.2

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 … Lars Klareskog

Annals of the rheumatic diseases · Jul 2026

Purpose

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

Methods

In this prospective cohort study, 309 anticitrullinated protein antibody-positive individuals with musculoskeletal 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 ultrasound findings preceding Doppler-active synovitis, particularly tendon involvement, were strongly associated with progression to clinical arthritis in anticitrullinated protein antibody-positive individuals and support an ultrasound-identified 'presynovitis' phase of rheumatoid arthritis development and early risk stratification.

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.

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.

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