Objective: This study aimed to investigate the clinical and ultrasonographic factors associated with radiographic progression at 1 year after treatment initiation in patients with treatment-naïve rheumatoid arthritis (RA). Methods: We consecutively enrolled treatment-naïve patients with RA who presented to our hospital between January 2018 and December 2023. Clinical disease activity indices, musculoskeletal ultrasound (MSUS) findings of 22 joints in the hands and wrists, and radiographic findings were evaluated at baseline and at the 1-year follow-up. Data were analyzed retrospectively. Results: A total of 265 patients were included. The median duration from symptom onset to treatment initiation was 3.6 months. Baseline disease activity was moderate, with mean Simplified Disease Activity Index and Clinical Disease Activity Index values of 21.2 and 19.5, respectively. All patients initiated treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs), and treatment was managed according to a treat-to-target strategy. At 1 year after treatment initiation, 110 patients (41.5%) received biologic or targeted synthetic DMARDs. Concurrently, 215 patients (81.1%) maintained radiographic remission of the hands and wrists, defined as a change in the modified total Sharp score (mTSS) of the hand and wrist (Δhand/wrist mTSS) of ≤ 0.5/year. Multivariable logistic regression analysis showed no significant association between clinical factors, including disease activity indices, and radiographic progression. The presence of power Doppler (PD) signals penetrating into bone erosions was the only independent factor associated with lower odds of maintained structural remission (odds ratio 0.20; 95% CI 0.09-0.46; P < 0.001). Conclusion: In treatment-naïve patients with RA, the presence of intraerosive PD signals on MSUS was associated with radiographic progression at 1 year after treatment initiation.

The purpose of this study was to illustrate the clinical and imaging properties of giant intraosseous cyst-like lesions (GICLs) of the metacarpal bones extending beyond the central diaphysis in rheumatoid arthritis (RA) patients on magnetic resonance (MR) images. A keyword search was conducted to extract GICLs of the metacarpal bones out of MR reports in RA patients. There were nine GICLs extending from the subchondral bone region beyond the central diaphysis of the metacarpal bones on MR images in eight subjects with RA (seven females, one male). The age range was from 60 to 87 years with a median age of 65.5 years. The average disease duration was 13.1 years. As for the disease activity, one was low, six were moderate and one was high. None of the nine lesions were visible on radiography. The Steinbrocker stage distribution was as follows: I (n = 3), II (n = 2), and III (n = 3). Intraosseous cyst-like lesion of the metacarpal bones on MR images is a relatively rare manifestation in patients with long-standing RA. Although the lesion seems to be derived from subcortical bone break, it is not necessarily erosive in nature.

Rheumatoid arthritis (RA) frequently involves the wrist joints, where early inflammation may induce subtle changes in carpal spatial architecture. This study investigated whether baseline (BL) ultrasound inflammation is associated with longitudinal changes in AI-derived compactness metrics and whether these metrics provide information complementary to conventional wrist radiographic scores. This study included 159 patients with early RA who underwent BL and follow-up (FU) bilateral wrist radiography and BL wrist ultrasound. Four AI-derived centroid-based compactness metrics—root-mean-square-radius (RMSR), mean pairwise distance (MPD), median radius (R50), and 90th-percentile-radius (R90)—were calculated, and their annualized changes were evaluated in relation to conventional wrist SvdH scores and BL ultrasound inflammation, including gray-scale (GS), power Doppler (PD), GS+PD, and vascularity percentage (VS%). Associations were assessed using correlation and subgroup analyses. AI-derived compactness metrics at BL and FU, as well as their annualized changes, were not significantly associated with conventional wrist radiographic scores. In contrast, BL ultrasound inflammation was significantly associated with subsequent increases in compactness metrics. BL GS, PD, and GS+PD scores showed significant positive correlations with annualized changes in RMSR, MPD, R50, and R90 (r = 0.18–0.25, p < 0.05). Subgroup analyses similarly demonstrated greater increases in compactness metrics in patients with positive GS or PD activity. Annualized changes in AI-derived compactness metrics were associated with baseline ultrasound inflammation but not with changes in conventional wrist radiographic scores. These findings suggest that AI-derived compactness metrics may provide complementary quantitative information on global carpal spatial architecture in early RA.