Dakkak YJ, et al. - This study examined the concordance of PE with MRI inflammation in metatarsophalangeal (MTP) joints. For comparison Metacarpophalangeal (MCP), joints were enrolled. Researchers recruited a total of 1759 MTP(2–5) and 1750 MCP(2–5) joints of 441 consecutive patients with early arthritis who had undergone PE (for joint swelling) and MRI. Synovial intermetatarsal bursae may enlarge upon inflammation and become palpable and were thus also analyzed. Analyses (frequencies, GEE) were conducted on joint level. In early arthritis, the absence of swelling of MTP joints is mostly accompanied by the absence of MRI-detected inflammation. In addition to synovitis, swollen MTP joints are also explained by tenosynovitis and intermetatarsal bursitis and partly unexplained by MRI. Their clinical relevance must be ascertained in longitudinal studies.