Tender joint counts, part of the composite disease activity score (CDAS), correlated well with patient-reported outcomes in a longitudinal study of 209 patients with rheumatoid arthritis (RA), but did not correlate with the sum scores of either grey-scale or power Doppler ultrasonography. At 6 months, the baseline tender joint count positively predicted the CDAS (P < 0.001–0.019) but negatively predicted ultrasonography sum scores (P < 0.001) in patients with RA who were treated with biologic DMARDs, suggesting that the presence of tender joints might not be indicative of inflammation.