Background Because recent advances in drug therapies for RA have increased the importance of early diagnosis, musculoskeletal ultrasonography (US) has become increasingly a part of daily rheumatologic practice as a sensitive and versatile tool for the detection of synovitis. Although the application of ACR/EULAR2010 Classification Criteriafor RA facilitates the evaluation of foot and ankle joints which were neglected by DAS28 scoring system, reports about ankle US pathologies in early RA are scarce.
Objectives This study aims to investigate characteristics of US findings in symptomatic ankles with early RA patients compared to those with established RA patients.
Methods We analyzed consecutive records of 100 ankles in 74 RA patients (fulfilling the 2010 criteria) who underwent a scan of symptomatic ankles with PDUS in our department because of clinical need. The association between US findings and clinical data, especially disease duration (DD), were analyzed. Statistical analysis was performed using the Fisher’s exact test and the Welch’s unpaired t test.
Results Among 100 ankles, synovitis of talocrural joint, subtalar joint, and talonavicular joint were detected in 35, 33, and 27 ankles, respectively. All together, synovitis of the joints which the talus participates was observed in 56 ankles. Ankle tenosynovitis was detected in 46 ankles at medial recess (mainly Tibialis posterior tendons), in 29 ankles at lateral recess (peroneal tendons), and in 10 ankles at anterior extensors. Overall ankle tenosynovitis was observed in 61 ankles. As for Achilles tendon (AT) involvement, retrocalcaneal bursitis, AT enthesitis, AT tendonitis, and AT paratendonitis was detected in 27, 22, 13, and 4 ankles, respectively. Overall AT involvement was observed in 39 ankles.
DD was significantly shorter in the ankles with tenosynovitis (11.4±21.6 months) than in the ankles without tenosynovitis (32.0±58.3 months) (p=0.039). DD was more significantly shorter in the ankles with “Isolated tenosynovitis” (which means ankle with tenosynovitis and without joint synovitis) (n=30, 5.9±8.7 months) than in all the other ankles (25.2±47.8 months) (p=0.0016).
When dividing the patients into those with early RA (DD <6 months) and those with established RA (DD ≥6 months), 100 ankles in 74 patients were classified into 62 ankles in 47 early RA patients (median DD 2.8 months) and 38 ankles in 27 established RA patients (median DD 17.4 months). Ankle joint synovitis, ankle tenosynovitis, and AT involvement was observed in 48%, 69%, and 39% of ankles with early RA, and in 68%, 47%, and 39% of ankles with established RA, respectively. Tenosynovitis was significantly more common in ankles with early RA than with established RA (p=0.0357). Isolated tenosynovitis was significantly more common in ankles with early RA (39%) than with established RA (16%) (p=0.0236).
Conclusions Isolated tenosynovitis is frequently detected by ultrasound in symptomatic ankles of RA patients with significantly shorter disease duration. US examination of symptomatic ankles in early RA patients should include the scans in the medial and lateral recess for ankle tenosynovitis.
Disclosure of Interest None Declared
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