Hammer HB, et al. - From a longitudinal observational study of 209 patients with established rheumatoid arthritis, the contributors sought to explore on patient and joint level the associations between ultrasound synovitis and joint swelling, tenderness and patient-reported joint pain (PRJP). Thirty two joints in upper/lower extremities for joint swelling/tenderness and grey scale (GS)/power Doppler (PD) synovitis were assessed. While tender joints had primary association with PRJP, swollen joints were strongly correlated with GS/PD at patient level. Strong relationship among swollen joints and ultrasound detected synovitis at both patient and joint level was noticed, although this was absent for tender joints. Reflection of ongoing inflammation in established RA of tender joints could be questioned.