Work

Quantitative assessment of synovial inflammation in rheumatoid arthritis using shear wave elastography: a pilot study

Year: 2026

Type: article

Abstract: Objective To evaluate the discriminatory performance of shear wave elastography (SWE) for detecting ultrasound-confirmed wrist synovitis in rheumatoid arthritis (RA), derive preliminary diagnostic cut-offs and examine associations between synovial stiffness and ultrasound inflammatory burden.Methods This cross-sectional pilot study included 133 participants: 60 patients with RA and ultrasound-confirmed synovitis, 30 patients with RA without ultrasound-confirmed synovitis, 30 healthy controls and 13 individuals with wrist ganglia. Bilateral radiocarpal and midcarpal recesses were assessed using B-mode ultrasound, power Doppler (PD) and SWE. Ultrasound-confirmed synovitis was prespecified as synovial hypertrophy (SH) grade ≥2, irrespective of PD. Associations between SWE and ultrasound inflammatory burden were assessed using recess-level linear mixed-effects models and participant-level analyses.Results Participant-level mean SWE showed high discriminatory performance within this pilot cohort for ultrasound-confirmed synovitis: area under the curve (AUC) 0.998 for kPa, with an optimal cut-off of 19.49 kPa (98.3% sensitivity; 100% specificity) and AUC 0.994 for m/s, with an optimal cut-off of 2.89 m/s (95.0% sensitivity; 100% specificity). Mean SWE was significantly higher in patients with ultrasound-confirmed synovitis than in all other groups (p<0.001). At the recess level, SWE increased progressively with wrist-adapted Global Outcome Measures in Rheumatology (OMERACT)-European Alliance of Associations for Rheumatology (EULAR) Synovitis Score, SH and PD grades (all p<0.001). After adjustment for Disease Activity Score in 28 joints using erythrocyte sedimentation rate, age, disease duration, current conventional synthetic disease-modifying antirheumatic drug use and current biologic disease-modifying antirheumatic drug use, wrist-adapted GLOESS mean and PD mean were independently associated with SWE.Conclusion SWE showed high discriminatory performance for ultrasound-confirmed synovitis within this single-operator pilot cohort and was closely associated with ultrasound inflammatory burden. The preliminary diagnostic cut-offs require independent validation, including assessment of interobserver reproducibility, before clinical implementation.

Source: RMD Open

DOI: 10.1136/rmdopen-2026-007652