Ankle pain in rheumatoid arthritis: comparison of clinical and sonographic findings

Hernández‐Díaz, Cristina; Sánchez-Bringas, Guadalupe; Ventura‐Ríos, Lucio; Román, Manuel Robles-San; Filippucci, Emilio

doi:10.1007/s10067-019-04532-2

Cited by 9 publications

(13 citation statements)

References 27 publications

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“…However, intuitively it is plausible that inflammatory findings such as tenosynovitis are related to symptoms. This is also corroborated by two studies who also found association between peroneal tenosynovitis and ankle pain duration or symptoms in rheumatoid arthritis, 17,18 but further studies are needed to confirm this. Interestingly, we found no association between radiographic imaging (CR and conebeam CT) and symptoms in ankle OA.…”

Section: Discussionsupporting

confidence: 74%

Diagnostic Performance of Ultrasonography for Evaluation of Osteoarthritis of Ankle Joint: Comparison With Radiography, Cone‐Beam CT, and Symptoms

Nevalainen

Pitkänen

Saarakkala

2021

J of Ultrasound Medicine

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Objectives-To determine the diagnostic performance of ultrasonography (US) for evaluation of the ankle joint osteoarthritic (OA) changes. Cone-beam computed tomography (CT) was used as the gold standard and US performance was compared with conventional radiography (CR). As a secondary aim, associations between the imaging findings and ankle symptoms were assessed.Methods-US was performed to 51 patients with ankle OA. Every patient had prior ankle CR and underwent cone-beam CT during the same day as US examination. On US, effusion/synovitis, osteophytes, talar cartilage damage, and tenosynovitis were evaluated. Comparison to respective imaging findings on CR and cone-beam CT was then performed. Single radiologist blinded to other modalities assessed all the imaging studies. Symptoms questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), was available for 48 patients.Results-US detected effusion/synovitis of the talocrural joint with 45% sensitivity and 90% specificity. For the detection of anterior talocrural osteophytes, US sensitivity was 78% and specificity 79%. For the medial talocrural osteophytes, they were 39 and 83%, and for the lateral talocrural osteophytes 54 and 100%, respectively. Considering cartilage damage of the talus, US yielded a low sensitivity of 18% and high specificity of 97%. Overall, the performance of US was only moderate and comparable to CR. The imaging findings showed only weak associations with ankle symptoms.Conclusions-The ability of US to detect ankle OA is only moderate. Interestingly, performance of CR also remained moderate. The associations between imaging findings and WOMAC score seem to be weak in ankle OA.

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Section: Discussionsupporting

confidence: 74%

Diagnostic Performance of Ultrasonography for Evaluation of Osteoarthritis of Ankle Joint: Comparison With Radiography, Cone‐Beam CT, and Symptoms

Nevalainen

Pitkänen

Saarakkala

2021

J of Ultrasound Medicine

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“…The ankle and foot are prone to numerous pathological conditions that may contribute to their eventual functional impairment. So the identification of the inflamed joint and/or tendon by ultrasound might provide useful information 5 . Only a few studies have focused on this area in RA.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound is a sensitive imaging tool that allows identification of the affected anatomic structures, explaining the cause of ankle pain when present and revealing subclinical disease in asymptomatic ankles 5 . Previous research has shown that ankle joint evaluation is undervalued in many clinical and sonographic scores used for RA patient evaluation and follow up.…”

Section: Introductionmentioning

confidence: 99%

“…4 Ultrasound is a sensitive imaging tool that allows identification of the affected anatomic structures, explaining the cause of ankle pain when present and revealing subclinical disease in asymptomatic ankles. 5 Previous research has shown that ankle joint evaluation is undervalued in many clinical and sonographic scores used for RA patient evaluation and follow up. More effort is required to detect the value of ankle joint examination in RA and the assessment of ultrasonographic signs according to frequency, disease duration, and activity.…”

Section: Introductionmentioning

confidence: 99%

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Ankle and foot pathologies in early rheumatoid arthritis, what can ultrasound tell us?

et al. 2022

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Background Rheumatoid arthritis (RA) is a systemic autoimmune polyarticular disease. Despite being commonly affected in RA, the ankle and foot do not receive much attention, particularly in early disease. The precise diagnosis of their involvement and its impact on health is a clinical challenge that requires accurate assessment. Aim To determine the role of ultrasound in evaluation of ankle and foot pathologies and assess its impact on functional activity in newly diagnosed RA patients. Methods The study was conducted on 152 RA patients and 52 healthy controls. Patients were subjected to history taking, clinical examination, and ultrasound scan. Impact on health was measured by health assessment questionnaire, as well as foot function index. Results In a cohort of patients with early RA with median duration of 1 month, tibialis posterior (TP) tenosynovitis (45.4%) was the most common pathology, followed by tibiotalar (TTJ) synovitis (39.8%), and peroneal tenosynovitis (39.1%). In terms of disease duration, TTJ (P = .001) foot pathologies were less common in early RA and tended to worsen over time, whereas TP (P = .048) and peroneal tenosynovitis (P = .011) were more common in early RA. In multivariate analysis TTJ, subtalar synovitis, forefoot pathologies, TP tenosynovitis, and Achilles enthesitis were found to be significant predictors of functional disability. The most important predictors of ankle pain were TTJ synovitis, TP tenosynovitis, peroneal tenosynovitis, and plantar fasciitis. Conclusion Ankle and foot involvement is a common issue of early RA, and it has a significant impact on quality of life. Ultrasound is a reliable tool for evaluating various abnormalities in this complex area, allowing for better management.

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“…However, US is more sensitive for detecting ankle and foot synovitis compared to clinical examination [177,178]. The added value of US in detecting inflammatory lesions [176,179,180] is proven, showing the importance of the method in characterizing disease activity. In the ankle and midfoot, the tibiotarsal (TT) and talonavicular joints are the most frequently affected joints [181][182][183][184] while in the forefoot the metatarsophalangeal (MTP) joints, especially MTP II-V, are most affected [183,185].…”

Section: Ankle and Footmentioning

confidence: 99%

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

et al. 2021

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The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.

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Ankle pain in rheumatoid arthritis: comparison of clinical and sonographic findings

Cited by 9 publications

References 27 publications

Diagnostic Performance of Ultrasonography for Evaluation of Osteoarthritis of Ankle Joint: Comparison With Radiography, Cone‐Beam CT, and Symptoms

Diagnostic Performance of Ultrasonography for Evaluation of Osteoarthritis of Ankle Joint: Comparison With Radiography, Cone‐Beam CT, and Symptoms

Ankle and foot pathologies in early rheumatoid arthritis, what can ultrasound tell us?

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

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