Does tenderness in non-swollen joints predict radiographic progression and persistence of inflammation?

Counting of tenderness and swelling in inflamed joints has traditionally been used to assess the disease activity in routine clinical practice and research.  Now, a recent study published in Annals of the Rheumatic Diseases (2022),  highlights the need to consider the tenderness, even in non-swollen joints for the evaluation of subsequent structural damage, in rheumatoid arthritis (RA). They also observed that in both rheumatoid and psoriasis arthritis (PsA), sonographic signs for synovitis and baseline radiographic damage are the two additional risk factors associated with radiographic progression.

The study conducted by Irina and team considered 1207 joints in 55 patients with RA and 352 joints in 18 patients with PsA for clinical and sonographic examination. The researchers observed a significant association between tenderness and radiographic progression after 2 years (OR 1.85, P=0.04) in RA patients. The Greyscale and power Doppler examination (PD, OR 2.92.8, P<0.001) showed a more significant association with erosions (OR 4.74, P<0.001) and structural damage. However, with regard to PsA, the association between tenderness and radiographic progression was positive, but not clinically significant (OR 1.72, P=0.23). On contrary, the effect of erosions (OR 4.62, P=0.019) and PD (OR 3.30, P=0.029) on subsequent structural damage was found to be remarkable in PSA patients.

A 2016 study by Cheung et al, evaluated the predictive value of tender joints for structural damage in RA, as opposed to synovitis. The researchers have concluded that synovitis is superior to tenderness in predicting the subsequent structural progression. However, at the level of an individual joint, they have noted that the co-existence of tenderness and synovitis is predictive of structural damage, especially in metacarpophalangeal joints.

The current study underscores the need to conduct a detailed evaluation of tenderness at the individual level, even for non-swollen joints, in RA and PsA.  However, it is necessary to evaluate the association between the persistence of tenderness in non-swollen joints and its predictive ability for structural progression through large randomized clinical trials.


  1. Gessl I, Hana CA, Deimel T, Durechova M, Hucke M, Konzett V, et al. Tenderness and radiographic progression in rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis. 2022 Oct 19;annrheumdis-2022-222787.
  2. Cheung PP, Mari K, Devauchelle-Pensec V, Jousse-Joulin S, D’Agostino MA, Chalès G, Gaudin P, Mariette X, Saraux A, Dougados M. Predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis. RMD Open. 2016 Mar 17;2(1):e000205.