Follow-up ended when patients developed clinically apparent IA (determined at physical examination), or else after 2 years. A detailed scanning and scoring protocol and information on dichotomization is provided in the Supplementary material, section ‘Methods’, available at Rheumatology online. MRI scores were dichotomized with data from age-matched symptom-free controls as reference. Unilateral contrast-enhanced 1.5 T MRI of MCP (2–5) and MTP (1–5) joints was also made at baseline and scored by two trained readers for synovitis (according to RAMRIS ) and tenosynovitis (according to Haavardsholm et al. At baseline the squeeze test was performed compression across the knuckles of MCP and MTP joints with the force of a firm handshake, as described previously. The study was approved by the local medical ethical committee. All patients gave written informed consent. Inclusion criteria were recent-onset (<1 year) arthralgia of small joints and a clinical suspicion for progression to RA, which means that according to the pattern recognition of the rheumatologist at first visit, imminent RA was more likely than other diagnoses, as described previously. Finally, we studied the association of the test with progression to inflammatory arthritis (IA).īetween April 2015 and October 2018, 315 patients were consecutively included in the Leiden CSA cohort details are provided in the Supplementary material, section ‘Methods’, available at Rheumatology online. MRI-detected tenosynovitis was also studied, because we assumed that tenosynovitis at MCP or MTP level may also produce pain upon compression. We specifically hypothesized that it is associated with subclinical synovitis, in line with the original assumption of the test being a measure of synovitis. We here aimed to assess if a positive squeeze test in patients with clinically suspect arthralgia (CSA) is associated with subclinical inflammation. MRI-detected subclinical inflammation has been shown to be predictive for RA development of all inflammatory features, tenosynovitis had the strongest association. The field of early arthritis is moving towards identifying patients at risk for RA in the phase of arthralgia. The sensitivity of the test, with MRI-detected synovitis as reference, was 31–33%. Previous studies in early arthritis indeed showed that a positive squeeze test was associated with presence of swollen MCP and MTP joints, as well as with local MRI-detected inflammation. A positive test is traditionally assumed to indicate presence of synovitis. Sir, The squeeze test (or compression test) is often used to quickly screen for arthritis in MCP and MTP joints. A positive squeeze test in clinically suspect arthralgia is associated with presence of subclinical synovitis.