Background/Purpose: Despite a pivotal role for RA patients mobility, the ankle joints are frequently neglected, and omitted in activity scoring systems including DAS 28. In addition, only few studies have assessed pathologies detected by ultrasonography of the ankle in symptomatic RA patients (1). Therefore, the type and degree of involvement of the ankle joints were evaluated in established RA patients regardless of symptomatology or duration of illness utilizing standardized high resolution musculoskeletal ultrasound (MSUS) including colour Doppler ultrasonography (CDUS).
Methods: A total number of 89 ankle joints of 45 consecutive RA patients fulfilling the ACR/EULAR classification criteria 2010 were examined using MSUS (Logic E9, GE Healthcare, Buckinghamshire, GB with a ML6-15 linear probe with 6- 15 MHz) and CDUS according to the EULAR MSUS guidelines (2). In addition, the talonavicular, the intertarsal- and the tarso-metatarsal joints were investigated. Furthermore, ankle pain (VAS score 0-10) and loss of function were recorded for each patient individually.
Results: 45 RA patients (32 female, 13 male) with a median age of 61 years (range 28 -81) and a disease duration of 5 years (0 – 43 range) were enrolled in our study. The median DAS28 was 5,0 (range 0,8 -7,8). Ankle pain was recorded for 27 patients, whereas 18 patients were completely asymptomatic regarding the ankles. Overall, the predominant pathology was arthritis of the tibiotalar and/or talonaviclar joint in 64% of the patients (29 out of 45), followed by tenosynovitis of the flexor tendons in 44% of the patients (20 out of 45). Pathologic B-mode findings were observed in 85% of the symptomatic patients (23/27), however, also 61% of the asymptomatic patients (11/18) exhibited pathologic B-mode findings (p=0.06). CDUS activity was higher in the subgroup of symptomatic patients with 33% (9/27) compared to 17% of asymptomatic patients (3/18) (p=0.13), for detailed information s. table 1.
Conclusion: Most frequent pathologies detected by MSUS were arthritis of the tibiotalar and talonavicular joint, followed by tenosynovitis of the flexor tendons. Pathologic findings are also common in asymptomatic patients with RA, whereas CDUS activity is predominately observed in symptomatic patients.
|
Pathologies Joints |
Arthritis only tibiotalar |
Arthritis tibiotalar and talonavicular |
Arthritis only talonavicular |
Tenosynovitis (M. tibialis posterior +/- or M. flexor digitorum) |
CDUS positive Arthritis or Tenosynovitits |
| All ankles (n = 89) | 29 | 16 | 1 | 20 | 12 |
| Symptomatic patients (n = 27) | 17 | 12 | 1 | 15 | 9 |
| Asymptomatic patients (n 0 18) | 12 | 4 | 0 | 5 | 3 |
References:
1 Suzuki T, Okamoto A, Clin Exp Rheumatol 2013, 31 (2): 281-284. 2 Backhaus M, Burmester G-R, Gerber T et al., Ann Rheum Dis 2001, 60: 641-649
Disclosure:
M. Alsuwaidi,
None;
B. P. Ehrenstein,
None;
M. Fleck,
None;
W. Hartung,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ankle-joint-involvement-in-rheumatoid-arthritis-an-ultrasound-study-using-high-resolution-and-colour-doppler-ultrasound/