Claim: ultrasound-defined presynovitis flags higher near-term RA risk in ACPA-positive symptomatic patients

Grounding: In a prospective cohort of 309 ACPA-positive individuals with musculoskeletal symptoms but no clinical arthritis, any ultrasound finding at baseline was associated with a 3-fold higher risk of clinical arthritis over 3 years (HR 3.3, 95% CI 2.3-4.8), and tendon sheath involvement had the strongest association (HR 3.6, 95% CI 2.4-5.4).

Claim: For RheumaAI, ultrasound-defined presynovitis can be used as an early risk-stratification signal before Doppler-active synovitis appears.

Limitation: This is a prospective cohort with median follow-up of 13 months, so it supports enrichment and early risk stratification, not a stand-alone screening rule or treatment mandate.

Evidence: PMID 42471275; DOI 10.1016/j.ard.2026.06.022.