Objective In clinically suspect arthralgia(CSA) ultrasound(US) can be used to detect subclinical joint-inflammation, which is a known predictor for progression to clinically apparent inflammatory arthritis(IA). Most US-protocols include both hands, while a more efficient, unilateral US approach is also sufficient, has never been investigated. Therefore, we described US-findings for one and both hands in CSA-patients and investigated if a US-protocol that includes one hand is as predictive as a protocol with two hands. Methods CSA-patients of two cohorts underwent bilateral US. Subclinical synovitis and tenosynovitis (Gray Scale ≥2 and/or Power Doppler ≥1) in one and both hands were described per hand and joint. Additionally, we analyzed the association between inflammatory arthritis (IA)-development and US-positivity. Results In total, 320 patients were studied. In cohort 1, 23% patients had bilateral US-detected subclinical (teno)synovitis, 20% only in the dominant hand and 10% only in non-dominant hand. In cohort 2, 10% had bilateral involvement, 12% in the dominant hand only and 8% in the nondominant hand only. US of the dominant hand predicted IA-development almost equal compared to US of both hands, with hazard ratios of 2.8(95%CI 1.3-6.0) for both hands and 2.6(95%CI 1.3-5.3) for the dominant hand in cohort 1. In cohort 2, HRs were comparable. Conclusion US-detected subclinical (teno)synovitis in CSA-patients is partly bilateral and partly unilateral. Predictive values for IA-development are comparable. To reduce scanning time in clinical practice one could consider scanning the one hand instead of both hands in patients with CSA.
Boeren et al. (2026) studied this question.