Is ankle involvement underestimated in rheumatoid arthritis? Results of a multicenter ultrasound study

Abstract

The aim of this study is to investigate the prevalence of subclinical ankle involvement by ultrasound in patients with rheumatoid arthritis (RA). The study was conducted on 216 patients with RA and 200 healthy sex- and age-matched controls. Patients with no history or clinical evidence of ankle involvement underwent US examination. For each ankle, tibio-talar (TT) joint, tibialis anterior (TA) tendon, extensor halux (EH) and extensor common (EC) tendons, tibialis posterior (TP) tendon, flexor common (FC) tendon and flexor hallux (FH) tendon, peroneous brevis (PB) and longus (PL) tendons, Achilles tendon (AT) and plantar fascia (PF) were assessed. The following abnormalities were recorded: synovitis, tenosynovitis, bursitis, enthesopathy and rupture. BMI, DAS28, RF ESR and CRP were also obtained. A total of 432 ankles of patients with RA and 400 ankles of healthy controls were assessed. In 188 (87%) patients with RA, US showed ankle abnormalities whereas, in control group, US found abnormalities in 57 (28.5 %) subjects (p = 0.01). The most frequent US abnormality in RA patients was TP tenosynovits (69/216) (31.9 %), followed by PL tenosynovitis (58/216) (26.9 %), TT synovitis (54/216) (25 %), PB tenosynovitis (51/216) (23.6 %), AT enthesopathy (41/216) (19 %) and AT bursitis (22/216) (10.2 %). In 118 RA patients out of 216 (54.6%), a positive PD was found. No statistically significant correlation was found between the US findings and age, disease duration, BMI, DAS28, RF, ESR and CRP. The present study provides evidence of the higher prevalence of subclinical ankle involvement in RA patients than in age- and gender-matched healthy controls identified by US.

Does patients’ opinion of remission in rheumatoid arthritis overlap ultrasound “true” remission? – a pilot study

“…No PD positivity was found on plantar flexors. Ankle involvement in RA seems to also be underestimated-in a previous study, ankle abnormalities were found in >80% of RA active patients [37]. No PDUS ankle pathology was found in our cohort of patients.…”

The relevance of ultrasound examination of the foot and ankle in patients with rheumatoid arthritis – a review of the literature

“…Gutierez et al [45] in a study on patients with RA and subclinical ankle involvement (asymptomatic patients without history or clinical evidence of ankle injury), identified US abnormalities at the level of the ankle in 87% of the patients, significantly more than in healthy individuals. The most frequently reported was tibialis posterior tenosynovitis (31.9% of patients), followed by peroneus longus tenosynovitis and TT synovitis (26.9% and 25% of patients, respectively), but they did not find a significant association between the US abnormalities and disease duration or disease activity.…”

Detection of subclinical synovial hypertrophy by musculoskeletal gray‐scale/ power Doppler ultrasonography in systemic lupus erythematosus patients: A cross‐sectional study

“…Each tendon and joint were assessed in both longitudinal and transverse planes. The total number of erosions were examined at 100 location sites (minimum) of each patient as described in Table . The setting of gray‐scale/power Doppler was 17 MHz frequency of B‐mode, 6.25 MHz frequency of power Doppler, and 610 MHz frequency of Power Doppler pulse repetition.…”