In patients with clinical suspect arthralgia, subclinical tenosynovitis of the biceps tendon is not an early feature of rheumatoid arthritis (RA) and was not found to predict development of inflammatory arthritis, according to a study published as a letter to the editor in Rheumatology.

Previous studies reported that shoulder involvement in patients with undifferentiated arthritis may predict RA development. In this study, the researchers hypothesized that tenosynovitis of the biceps tendon identified by ultrasound may also be associated with development of inflammatory arthritis.

Using data from the SONAR study, the researchers identified subjects with subclinical arthritis diagnosed on ultrasound of the hands, shoulders and feet. Ultrasound was performed by 2 experienced and trained ultrasonographers, using a standardized protocol and scoring system. The participants were followed for 1 year for development of clinically apparent inflammatory arthritis.

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The study sample included 140 patients (82% women, mean age 45 years). At 1 year, 37 patients (22%) had developed inflammatory arthritis, including 17 patients (46%) with RA.

A sonographic evidence of shoulder abnormalities was found in 50 patients (29%). Subclinical tenosynovitis of the biceps tendon was documented in 15% of patients with clinically suspect arthralgia that developed inflammatory arthritis, and in 11% of patients with arthralgia that did not develop inflammatory arthritis (P =.48).  Similarly, there was no association between bilateral tenosynovitis, thickened biceps tendon and subdeltoid bursa effusion with development of inflammatory arthritis or RA.

The study had several limitations, including the low number of patients that developed inflammatory arthritis or RA and the frequency of ultrasound abnormalities.

“Based on these results, standard US screening of the shoulder is not necessary in clinically suspect arthralgia patients for determining their risk of developing IA,” concluded the experts.


Rogier C, van der Ven M, van der Helm-van Mil AHM, de Jong PHP. Is shoulder involvement in clinically suspect arthralgia an early feature of rheumatoid arthritis? A longitudinal ultrasound study. Rheumatology (Oxford). Published online Mar 2, 2020. doi:10.1093/rheumatology/keaa052