Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Recent magnetic resonance imaging (MRI)-studies revealed that tenosynovitis in the hands is associated with rheumatoid arthritis (RA). Although the forefoot is a preferential location for RA-inflammation, it is unknown whether MRI-detected tenosynovitis at the level of metatarsophalangeal (MTP)-joints is associated with RA. In addition anatomic literature leaves it undetermined if tendons at MTP-joints are surrounded by a synovial sheath. These questions were investigated.
Methods: Macroscopically, 14 forefeet of donated bodies were examined at the flexor-tendons and extensor-tendons for the presence and course of tendon sheaths. Tissue surrounding tendons was injected with blue-dyed resin or silicon. Presence of a sheath was also studied by light-microscopy. 624 persons (157 patients presenting with RA, 284 with other early arthritides and 193 symptom-free persons from the general population) underwent 1.5T MRI of unilateral MTP(1-5)-joints. Images were scored by two readers for tenosynovitis, synovitis and bone marrow oedema.
Results: Macroscopically, all extensor and flexor tendons crossing MTP-joints demonstrated clearly demarcated sheaths surrounding tendons. Microscopy revealed a synovial sheath. MRI-detected tenosynovitis occurred in 42% of RA-patients, 22% with other arthritidesand 1.6% of symptom-free controls. Compared to other arthritides, MRI-detected tenosynovitis was associated with RA, OR 2.38 (95%CI 1.5-3.8) for flexor and OR 3.13 (95%CI 1.9-5.2) for extensor tendons. The sensitivity of tenosynovitis in RA was 42%. The specificity compared to other arthritideswas 78%, and compared to symptom-free controls 98%.
Conclusion: Tenosynovium is present surrounding flexor and extensor tendons at MTP-joints. MRI-detected tenosynovitis of MTP-joints is specific for RA.
To cite this abstract in AMA style:Dakkak Y, Jansen F, DeRuiter M, Reijnierse M, van der Helm-van Mil A. Tenosynovitis at the Metatarsophalangeal Joints, a Novel Feature of RA: Results from an Anatomical and Large Magnetic Resonance Imaging Study of Tendon Sheaths of the Forefoot [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/tenosynovitis-at-the-metatarsophalangeal-joints-a-novel-feature-of-ra-results-from-an-anatomical-and-large-magnetic-resonance-imaging-study-of-tendon-sheaths-of-the-forefoot/. Accessed July 14, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tenosynovitis-at-the-metatarsophalangeal-joints-a-novel-feature-of-ra-results-from-an-anatomical-and-large-magnetic-resonance-imaging-study-of-tendon-sheaths-of-the-forefoot/