The involvement of ankles in systemic lupus erythematosus (SLE) has not been widely studied. The aim of our prospective study was to determine the characteristics of the ankle joint and tendon involvement in SLE using ultrasound (US) as an imaging modality. Sixty consecutive patients with SLE underwent a detailed clinical evaluation and US examination. Gray-scale and power Doppler US of the bilateral tibiotalar (TT) joints, subtalar (ST) joints, and ankle tendons were performed using a multiplanar scanning technique. Joint effusion, synovitis, tenosynovitis, enthesitis, and vascularization were assessed according to the OMERACT recommendations. The Total Ankle Ultrasound Score (TAUSS) was calculated as the sum of the grades of joint effusion and synovial hypertrophy for both TT and ST joints bilaterally (ranging from 0-24) and power Doppler activity was assessed separately. Finally, US findings were correlated with physical evaluation, laboratory parameters, and SLE activity scores. US ankle joint involvement was present in 32/60 (53.3%) patients. TT joints were affected in 26 (43.3%) and ST joints in 16 (26.7%) patients. Thirteen (21.7%) patients had US tendons and/or enthesal involvement. TT joint effusion was the most frequent finding, present in 55/240 (22.9%) examined joints, followed by synovial hypertrophy detected in 18/240 (7.5%) joints. The median (interquartile range; range) TAUSS of the US-affected joints was 1 (0-2; range 1-10). There were no significant correlations between US findings and inflammatory parameters or serological parameters of disease activity, but we found a weak positive correlation between TAUSS and the European Consensus Lupus Activity Measurement (r = 0.281, P = .029). This study revealed a high prevalence of pathological US ankle changes in patients with SLE and a positive correlation between ankle US involvement and disease activity score (European Consensus Lupus Activity Measurement).

BackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with heterogeneous clinical manifestations. The musculoskeletal involvement is among commonest and earliest symptoms occurring in 95% of patients. The clinical examination of the ankle joints may underestimate the type and distribution of pathological changes. Musculoskeletal ultrasound (US) is a useful diagnostic tool for evaluation of joints and tendons in the majority of inflammatory rheumatic diseases.ObjectivesThe aim of this study is to assess the ankle joints and tendons involvement in SLE patients using US and to correlate the findings with the physical examination, laboratory tests and disease activity scores.MethodsForty consecutive SLE patients were enrolled in the study and underwent clinical evaluation, laboratory tests and bilateral high-resolution US on the same day. Grey-scale and power Doppler (PD) US of the talocrural (TC), subtalar joints (ST), ankle tendons, second and third MCP joints, second and third PIP joints, wrists and second and third MTP joints were performed.ResultsA total of 720 joints and 800 tendons were examined. US detected inflammatory joint abnormalities were present in 35/40 (87,5%) patients while tenosynovitis was present in 7/40 (17,5%) patients. The most frequently affected were MTP joints (67,5%) followed by MCP(42,5%) and TC joints (40%), wrists (27,5%) and PIP joints (7,5%). The most prevalent pathological US finding was joint effusion.Synovial hypertrophy and positive PD signal were less frequently observed. Effusion in TC joints was present in 40%, synovial hypertrophy in 20% and positive PD in 2,5% of the patients. Only two patients had bony erosions detected.Six out of forty patients (15%) reported pain or swelling in ankle joints and two(33%) of them didn’t have any US abnormalities.As many as 47% of patients without inflammatory joint symptoms had pathological US findings in ankle joints. The most commonly affected tendon was tibialis anterior (7,5% of patients), followed by extensor halluces longus tendon (5% of patients).ConclusionResults of this study show a high prevalence of US verified inflammatory joint changes in SLE patients, while tendon changes were extremely rare. Foot joints were most commonly affected, followed by wrists and ankle joints. It is important to stress that a great number of asymptomatic patients had pathological US findings in ankle joints. From this and previous studies it is clear that US should be used more in the periodical assessment of the musculoskeletal system in patients with SLE.References[1] Iagnocco A, Ceccarelli F, Rizzo C, Truglia S, Massaro L, Spinelli FR, et al. Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus. Rheumatology. 2014;53(3):465–72.[2] DelleSedie A, Riente L, Scire CA, Iagnocco A, Filippucci E, Meenagh G, et al. Ultrasound imaging for the rheumatologist XXIV. Sonographic evaluation of wrist and hand joint and tendon involvement in systemic lupus erythematosus. ClinExpRheumatol. 2009;27(6):897...