Background Ankle joint evaluation is underestimated in many clinical and sonographic scores used for evaluation and follow-up of rheumatoid arthritis (RA) patients. Moreover, sonographic scores which included the ankle joint had no agreement on examination parameters. More effort is needed to detect the value of the ankle joint examination in RA and also a description of the earliest and the most frequent ultrasonographic signs that should be considered in ankle assessment (1).
Objectives detection of ankle affection by ultrasound (US) in active RA and correlate this finding with disease duration, DAS28-ESR 28 score and rheumatoid factor (RF).
Methods 126 ankle joints and tendons of 63 active RA patients, aged above 18 years old were included in the study. US examination was done to the tibiotalar and talonavicular joints for synovitis and/or effusion on Greyscale (GS) mode and power doppler (PD). The anterior, lateral and posterior ankle tendons were examined for tenosynovitis and tendinosis.
Results The mean age and ± standard deviation were 35.1±8.3 with the female-to-male ratio 2:1. The mean disease duration was 22.7±9.6 months. The mean DAS28-ESR 28 score was 3.05±0.66. The most frequent pathologies detected were tenosynovitis of the flexor, extensor or peroneal tendons (found in 30.2% of the affected ankles); followed by synovitis of the tibiotalar and talonavicular joints (18.3%); next was erosion (8.7%) and lastly tendinosis (4%). The earliest sonographic signs were tenosynovitis, followed by synovitis, erosion, and lastly tendinosis.
Conclusions It can be stated that ankle evaluation should be considered more in RA assessment. The tibialis anterior and posterior tendons, the tibiotalar and talonavicular joints were the commonest and most frequent sites to be involved in the ankle. Tenosynovitis appears earlier than synovitis. DAS28-ESR score was correlated to synovitis and tenosynovitis but not to erosion. Bilaterality and erosion were correlated with disease duration. RF positivity has a positive correlation with positive US findings in the ankle region.
Alsuwaidi M, Ehrenstein BP, Fleck M, Hartung W: Ankle Joint Involvement In Rheumatoid Arthritis. An Ultrasound Study Using High Resolution-and Colour Doppler Ultrasound. In: Arthritis and Rheumatism: 2013: Wiley-Blackwell.
Disclosure of Interest None declared