Early clinical and imaging features of rheumatoid arthritis: towards a more complete picture

Abstract

Rheumatoid arthritis (RA) is a highly prevalent rheumatic and auto-immune disease. Treatment should be initiated swiftly to improve patient outcomes, but is regularly delayed due to difficulties in diagnosing early arthritis on physical joint examination. The development and validation of a clinical rule to assist general practitioners in early detection of arthritis is presented. Furthermore, several novel MRI-detected inflammation features are assessed for their diagnostic and prognostic value. Tenosynovitis and intermetatarsal bursitis are shown to be prevalent juxta-articular synovial inflammation features during early RA development, which may precede clinically detectable arthritis. Moreover, these features contribute to the clinical picture of RA with joint tenderness, joint swelling and functional impairments; a notion that extends the prevailing traditional view of RA as a disease of the intra-articular synovium. Interosseous tendon inflammation, in contrast, is shown to be a non-synovial form of juxta-articular inflammation that has limited specificity for RA since it occurs regularly in other early arthritides. Lastly, a large study in the phase of clinically suspect arthralgia shows that work-related physical strain at higher ages associates with increased subclinical tenosynovitis and progression to RA, fuelling a novel hypothesis that mechanical stress is a key link in unravelling the origin of RA.