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Risk factors of persistent synovitis development in early undifferentiated arthritis patients



Persistent synovitis (PS) may lead to erosive joint damage and result in functional disability.


The aim of the study was to identify the risk factors for development of PS in early undifferentiated arthritis patients (EUA) attending Al Sharqia Governorate Hospitals, Egypt.

Patients and methods

A total of 80 EUA patients comprised the patients group. Assessment was performed twice (baseline and after 1 year) using clinical, laboratory, functional, and radiological [high resolution ultrasonography (HRUS) and power Doppler (PD)] assessments.


Among 80 patients assessed, 20 (25%) showed evidence of self-limiting arthritis and 60 (75%) had PS (PS):16 (27%) developed rheumatoid arthritis, 14 (23%) progressed to spondyloarthropathy, and 30 (50%) remained undifferentiated (UA). Baseline tender and swollen Joint Counts (TJC and SJC) and anti-CCP2 titer were significantly evident in PS patients. Baseline HRUS total score of synovitis and PD total score were significantly higher in PS patients. Family history of any specific rheumatic disease, SJC, anti-CCP2 titer, HRUS total synovitis score, and PD total score were the significant risk factors of PS development. The most significant risk factor of PS (logistic regression analysis) was the baseline PD total score.


Baseline PD total score is the most significant risk factor for development of PS in EUA patients.


PD examination of all patients presenting with EUA should be performed.


  1. El Miedany Y, Youssef S, Mehanna AN, El Gaafary M, et al. Development of a scoring system for assessment of outcome of early undifferentiated inflammatory synovitis. Joint Bone Spine 2008; 75:155–162.

    Article  Google Scholar 

  2. Ghosh P, Karmakar PS, Mahapatra PS, Dhar SK, Ghosh A, et al. A prospective study for outcome and prediction of early arthritis: a tertiary care centre observation. Indian J Rheumatol 2010; 5:106–111.

    Article  Google Scholar 

  3. Raza K, Filer A. Predicting the development of RA in patients with early undifferentiated arthritis. Best Pract Res Clin Rheumatol 2009; 23:25–36.

    Article  Google Scholar 

  4. Schumacher HR. Early arthritis clinics: much early arthritis is unclassified. J Rheumatol 2002; 29:2258–2260.

    PubMed  Google Scholar 

  5. Mark AQ, Michael JG, Helena MO, Susanna P, Zunaid K, Richard J, et al. Prognostic factors in a large cohort of patients with early undifferentiated arthritis after application of a structured management protocol. Arthritis Rheum 2003; 48:3039–3045.

    Article  Google Scholar 

  6. Bos WH, Wolbink GJ, Boers M, Tijhuis GJ, de Vries N, Van der Horst-Bruinsma IE, et al. Arthritis development in arthralgia patients is strongly associated with anti-citrullinated protein antibody status: a prospective cohort study. Ann Rheum Dis 2010; 69:490–494.

    Article  CAS  Google Scholar 

  7. Salaffi F, Filippucci E, Carotti M, Naredo E, Meenagh G, Ciapetti A, Savic V, Grassi W, et al. Inter-observer agreement of standard joint counts in early rheumatoid arthritis: a comparison with grey scale ultrasonography — a preliminary study. Rheumatology (Oxford) 2008; 47:54–58.

    Article  CAS  Google Scholar 

  8. Wolfe F, Ross K, Hawley F, Roberts FK, Cathey MA, et al. The prognosis of rheumatoid arthritis and undifferentiated polyarthritis syndrome in the clinic: a study of 1141 patients. J Rheumatol 1993; 20:2005–2009.

    PubMed  CAS  Google Scholar 

  9. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31:315–324.

    Article  CAS  Google Scholar 

  10. Dougados M, Van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy. Arthritis Rheum 1991; 34:1218–1227.

    Article  CAS  Google Scholar 

  11. Fries JF, Spitz P, Kraines RG, Holman HR, et al. Measurement of patient outcomes in arthritis. Arthritis Rheum 1980; 23:137–145.

    Article  CAS  Google Scholar 

  12. Rojas-Serrano J, Burgos-Vargas R, Pérez L, García CG, Moctezuma F, Vázquez-Mellado J, et al. Very recent onset arthritis: the value of initial rheumatologist evaluation and anti-cyclic citrullinated peptide antibodies in the diagnosis of rheumatoid arthritis. Clin Rheumatol 2009; 28:1135–1139.

    Article  Google Scholar 

  13. Van der Heijde DM, van Leeuwen MA, van Riel PL, Koster AM, van ‘t Hof MA, van Rijswijk MH, van de Putte LB. Biannual radiographic assessments of hands and feet in a 3-year prospective follow up of patients with early rheumatoid arthritis. Arthritis Rheum 1992; 35: 26–34.

    Article  Google Scholar 

  14. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA, et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60:641–649.

    Article  CAS  Google Scholar 

  15. Marcin S, Michel C, Soren J, Mette K, Henrik ST, Mikkel O, et al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003; 48:955–962.

    Article  Google Scholar 

  16. Shankar S, Dhiman P, Kumar PG. Early undifferentiated arthritis in India: a six month follow up study. Indian J Rheumatol 2010; 5:118–123.

    Article  Google Scholar 

  17. Thabet M, Huizinga T, van der Heijde D, van der Helm-van Mil AH, et al. The prognostic value of baseline erosions in undifferentiated arthritis. Arthritis Res Ther 2009; 11:R155.

    Article  CAS  Google Scholar 

  18. Jansen LM, van Schaardenburg D, van der Horst-Bruinsma IE, Dijkmans BA, et al. One-year outcome of undifferentiated polyarthritis. Ann Rheum Dis 2002; 61:700–703.

    Article  CAS  Google Scholar 

  19. Raissouni R, Gossec L, Ayral X, Dougados M, et al. New concepts in the diagnosis and treatment of recent onset polyarthritis. Joint Bone Spine 2005; 72:119–123.

    Article  Google Scholar 

  20. Quinn MA, Gough AK, Green MJ, Green MJ, et al. Anti-CCP antibodies measured at disease onset help identify seronegative rheumatoid arthritis and predict radiological and functional outcome. Rheumatology (Oxford) 2006; 45:478–480.

    Article  CAS  Google Scholar 

  21. Berglin F, Johansson T, Sundin U, et al. Radiological outcome in rheumatoid arthritis is predicted by the presence of antibodies against cyclic citrullinated peptide before and at disease onset and by IgA-rheumatoid factor at disease onset. Ann Rheum Dis 2006; 65:453–458.

    Article  CAS  Google Scholar 

  22. Quinn M, Emery P. Are early arthritis clinics necessary? Best Pract Res Clin Rheumatol 2005; 19:1–17.

    Article  Google Scholar 

  23. Visser H, le Cessie S, Vos K, Breedveld FC, Hazes JM, et al. How to diagnose rheumatoid arthritis early: a prediction model for persistent (erosive) arthritis. Arthritis Rheum 2002; 46:357–365.

    Article  Google Scholar 

  24. Wakefield RJ, Green MJ, Marzo-Ortega H, Conaghan PG, Gibbon WW, McGonagle D, et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 2004; 63:382–385.

    Article  CAS  Google Scholar 

  25. Van de Stadt LA, Bos WH, Meursinge Reynders M, Wieringa H, Turkstra F, van der Laken CJ, van Schaardenburg D, et al. The value of ultrasonography in predicting arthritis in auto-antibody positive arthralgia patients: a prospective cohort study. Arthritis Res Ther 2010; 12:R98.

    Article  Google Scholar 

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Correspondence to Enass A. Elewa MD.

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Nageeb, G.S., Elewa, E.A., Azmy, T.M. et al. Risk factors of persistent synovitis development in early undifferentiated arthritis patients. Egypt Rheumatol Rehabil 41, 79–84 (2014).

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