Objectives The squeeze-test of metatarsophalangeal (MTP-)joints is frequently used, because it is easy and cheap. It is traditionally perceived as a test for synovitis. Besides classic intra-articular synovitis, also tenosynovitis and intermetatarsal bursitis (IMB) represent synovial inflammation, albeit juxta-articularly located. Both are frequently present in RA and occasionally in other arthritides. Therefore, we hypothesised that tenosynovitis and IMB contribute to a positive MTP-squeeze-test. Methods A cross-sectional study-design was used. 192 early arthritis patients and 693 clinically suspect arthralgia (CSA) patients underwent the MTP-squeeze-test and forefoot-MRI at first presentation. MRI-measurements in age-matched healthy controls were used to define positivity for synovitis, tenosynovitis and IMB. Logistic regression was used. Results In early arthritis patients synovitis (OR 4.8 (95%CI 2.5–9.5)), tenosynovitis (2.4 (1.2–4.7)) and IMB (1.7 (1.2–2.6)) associated with MTP-squeeze-test positivity. Synovitis (3.2 (1.4–7.2)) and IMB (3.9 (1.7–8.8)) remained associated in multivariable analyses. Of patients with a positive MTP-squeeze-test, 79% had synovitis or IMB: 12% synovitis, 15% IMB and 52% both synovitis and IMB. In CSA-patients, subclinical synovitis (3.0 (2.0–4.7)), tenosynovitis (2.7 (1.6–4.6)) and IMB (1.7(1.2–2.6)) associated with MTP-squeeze-test positivity, with the strongest association for synovitis in multivariable analysis. Of positive MTP-squeeze-tests, 39% had synovitis or IMB: 10% synovitis, 15% IMB and 13% both synovitis and IMB. Conclusion Besides synovitis, IMB contributes to pain upon compression in early arthritis, presumably due to its location between MTP-joints. This is the first evidence showing that MTP-squeeze-test positivity is not only explained by intra- but also juxta-articular inflammation.
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