Background/Purpose: Ankle involvement is common in Rheumatoid Arthritis (RA). It has been reported that more than 90 % of patients develop ankle symptoms over the course of the disease. In spite of this, it remains a neglected anatomical area since clinical implications of ankle involvement appear to be continuously underestimated. We analized the ultrasound (US) features of the Achilles Tendon (AT) and enthesis in patients with RA and compared these to healthy athletes. Relations between these findings and clinical and physical therapy parameters were identified.

Methods: Consecutive patients aged ≥18 with RA according to ACR/EULAR 2010 criteria were included. We consigned socio-demographic data, disease duration, physical activity and Body Mass Index (BMI). Clinical evaluation relied on the Disease Activity Score 28 (DAS28), Health Assessment Questionnaire (HAQ), Routine Assessment of Patient Index Data 3 (RAPID 3), as well as on a visual analog scale (VAS), and entheseal pain. Separately, AT thickness and echogenicity were examined bilaterally with US in 60 ankle regions. US examinations were performed by two experienced rheumatologists. To evaluate AT involvement, we used the Madrid Sonographic Enthesitis Index (MASEI) evaluating elementary lesions: bursitis, calcification, erosion, Power Doppler (PD), thickening of tendon, and structural change. Statistical analysis: Standard descriptive results were expressed as the mean ± standard deviation (SD). Chi-square Test and Fisher’s exact test were used for categorical variables whereas T test for the continuous variables.

Results: A total of 60 ankles from 30 patients with RA and 36 ankles from 18 healthy controls were assessed. The mean (±SD) age was 58.3 ± 9.5 years and disease duration were 14.5 ± 5.9 years in RA patients. 30% of patients with RA had foot and ankle pain at visit. The mean (±SD) DAS28, HAQ and RAPID3 were 3.46 ± 0.9, 0.9 ± 0.6, and 11 ± 6.5 respectively. 26.7% were obese. 30% of RA patients performed physical activity. At least 1 AT lesion was found in US of all RA patients. The most frequent US abnormality in RA patients was tibialis posterior tenosynovitis followed by peroneus longus tenosynovitis. A statistically significant difference was found between RA patients and healthy controls in mean (±SD) MASEI (3.56 ± 2.4 vs. 2.33 ± 1.7, p=0.01), and subitem scores such as: structural changes (0.66 ± 0.4 vs. 0.2 ± 0.4, p=<0.01), erosion (0.8 ± 1.3 vs. 0.02 ± 0.16, p=<0,01) and PD (0.3 ± 0.9 vs. 0.02 ± 0.16, p=0.03).

Conclusion: Achilles tendon involvement is rather frequent in RA patients. The MASEI score was significantly higher in patients with RA compared with athletes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-there-achilles-tendon-damage-in-rheumatoid-arthritis-patients/