Quantitative assessment of synovial inflammation in rheumatoid arthritis using shear wave elastography: a pilot study
5 affiliations
- 1IDIBAPS and Faculty of Medicine, University of Barcelona, Barcelona, Spain
- 2Rheumatology Department, Hospital Clínic Barcelona, Barcelona, Spain
- 3Department of Radiology, Hospital del Mar, Barcelona, Spain
- 4Faculty of Health and Life Sciences, School of Medicine, International University of Ecuador, Quito, Ecuador
- 5Department of Orthopaedics and Trauma Surgery, Hospital Clínic Barcelona, Barcelona, Spain
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.
Related
- Pan-immune-inflammation value and sleep disturbances in rheumatoid arthritis : A population-based NHANES study
- Sanguinarine ameliorates rheumatoid arthritis by activating the Hippo-YAP/TAZ pathway to induce apoptosis and suppress inflammation in fibroblast-like synoviocytes
- A mixture of pomegranate peels and propolis extracts reduces inflammation associated with rheumatoid arthritis in vivo
- Shear wave elastography for quantitative assessment of nerve tissue stiffness after sciatic nerve decompression in diabetic rats
- Cardiovascular risk assessment using the DAS28-GGT score in rheumatoid arthritis patients initiating JAK inhibitors: Results from the MAJIK-SFR registry
BibTeX
@article{ramirez2026quantitative,
title = {{Quantitative assessment of synovial inflammation in rheumatoid arthritis using shear wave elastography: a pilot study}},
author = {Julio Ramírez and Raimon Sanmartí and Virginia Ruiz-Esquide and José A Gómez-Puerta and Ana Belen Azuaga and Salvatore Marsico and Helena Florez and Miguel Martín-Mateo and Beatriz Frade-Sosa and Juan-Camilo Sarmiento-Monroy and Andrés Ponce and Sandra Farietta-Varela and Patricia Corzo and Laia Sabaté-Cequier and Claudia Arango and Joshua Peñafiel-Sam and Andrea Zacarías},
journal = {RMD Open},
year = {2026},
month = nov,
doi = {10.1136/rmdopen-2026-007652},
url = {https://doi.org/10.1136/rmdopen-2026-007652},
note = {CC BY},
}
RIS
TY - JOUR
TI - Quantitative assessment of synovial inflammation in rheumatoid arthritis using shear wave elastography: a pilot study
AU - Julio Ramírez
AU - Raimon Sanmartí
AU - Virginia Ruiz-Esquide
AU - José A Gómez-Puerta
AU - Ana Belen Azuaga
AU - Salvatore Marsico
AU - Helena Florez
AU - Miguel Martín-Mateo
AU - Beatriz Frade-Sosa
AU - Juan-Camilo Sarmiento-Monroy
AU - Andrés Ponce
AU - Sandra Farietta-Varela
AU - Patricia Corzo
AU - Laia Sabaté-Cequier
AU - Claudia Arango
AU - Joshua Peñafiel-Sam
AU - Andrea Zacarías
PY - 2026
DA - 2026/11/08
JO - RMD Open
DO - 10.1136/rmdopen-2026-007652
UR - https://doi.org/10.1136/rmdopen-2026-007652
AB - 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.
SN - 2056-5933
ER -