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Vega-Fernandez P, De Ranieri D, Oberle E, Clark M, Bukulmez H, Lin C, Shenoi S, Thatayatikom A, Woolnough L, Benham H, Brunner E, Henrickson M, Pratt LR, Proulx-Gauthier JP, Janow G, Cassedy A, Ting TV, Roth J. Comprehensive and reliable sonographic assessment and scoring system for inflammatory lesions of the paediatric ankle. Rheumatology (Oxford) 2023; 62:2239-2246. [PMID: 36308429 PMCID: PMC10234197 DOI: 10.1093/rheumatology/keac622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE The clinical decision-making process in paediatric arthritis lacks an objective, reliable bedside imaging tool. The aim of this study was to develop a US scanning protocol and assess the reliability of B-mode and Doppler scoring systems for inflammatory lesions of the paediatric ankle. METHODS As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) US group, 19 paediatric rheumatologists through a comprehensive literature review developed a set of standardized views and scoring systems to assess inflammatory lesions of the synovial recesses as well as tendons of the paediatric ankle. Three rounds of scoring of still images were followed by one practical exercise. Agreement among raters was assessed using two-way single score intraclass correlation coefficients (ICC). RESULTS Of the 37 initially identified views to assess the presence of ankle synovitis and tenosynovitis, nine views were chosen for each B-mode and Doppler mode semi-quantitative evaluation. Several scoring exercises and iterative modifications resulted in a final highly reliable scoring system: anterior tibiotalar joint ICC: 0.93 (95% CI 0.92, 0.94), talonavicular joint ICC: 0.86 (95% CI 0.81, 0.90), subtalar joint ICC: 0.91 (95% CI 0.88, 0.93) and tendons ICC: 0.96 (95% CI 0.95, 0.97). CONCLUSION A comprehensive and reliable paediatric ankle US scanning protocol and scoring system for the assessment of synovitis and tenosynovitis were successfully developed. Further validation of this scoring system may allow its use as an outcome measure for both clinical and research applications.
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Affiliation(s)
- Patricia Vega-Fernandez
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Deirdre De Ranieri
- Division of Rheumatology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Edward Oberle
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Matthew Clark
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hulya Bukulmez
- Division of Pediatric Rheumatology, Department of Pediatrics, Metro Health Medical System, Case Western Reserve University, Cleveland, OH, USA
| | - Clara Lin
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
| | - Susan Shenoi
- Seattle Children’s Hospital and Research Center University of Washington, Seattle, WA, USA
| | - Akaluck Thatayatikom
- AdventHealth Medical Group Pediatric Rheumatology and Immunology, Orlando, FL, USA
| | | | - Heather Benham
- Department of Pediatrics, Scottish Rite for Children, Frisco, TX, USA
| | - Emily Brunner
- Department of Pediatrics, Geisinger Medical Center, Danville, PA, USA
| | - Michael Henrickson
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Laura R Pratt
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ginger Janow
- Joseph M. Sanzari Children’s Hospital, Hackensack, NJ, USA
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy V Ting
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Abdelzaher MG, Finzel S, Abdelsalam A, Enein AF, Abdelsalam N. Ankle and foot pathologies in early rheumatoid arthritis, what can ultrasound tell us? Int J Rheum Dis 2022; 25:1315-1323. [PMID: 36017618 DOI: 10.1111/1756-185x.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic autoimmune polyarticular disease. Despite being commonly affected in RA, the ankle and foot do not receive much attention, particularly in early disease. The precise diagnosis of their involvement and its impact on health is a clinical challenge that requires accurate assessment. AIM To determine the role of ultrasound in evaluation of ankle and foot pathologies and assess its impact on functional activity in newly diagnosed RA patients. METHODS The study was conducted on 152 RA patients and 52 healthy controls. Patients were subjected to history taking, clinical examination, and ultrasound scan. Impact on health was measured by health assessment questionnaire, as well as foot function index. RESULTS In a cohort of patients with early RA with median duration of 1 month, tibialis posterior (TP) tenosynovitis (45.4%) was the most common pathology, followed by tibiotalar (TTJ) synovitis (39.8%), and peroneal tenosynovitis (39.1%). In terms of disease duration, TTJ (P = .001) foot pathologies were less common in early RA and tended to worsen over time, whereas TP (P = .048) and peroneal tenosynovitis (P = .011) were more common in early RA. In multivariate analysis TTJ, subtalar synovitis, forefoot pathologies, TP tenosynovitis, and Achilles enthesitis were found to be significant predictors of functional disability. The most important predictors of ankle pain were TTJ synovitis, TP tenosynovitis, peroneal tenosynovitis, and plantar fasciitis. CONCLUSION Ankle and foot involvement is a common issue of early RA, and it has a significant impact on quality of life. Ultrasound is a reliable tool for evaluating various abnormalities in this complex area, allowing for better management.
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Affiliation(s)
- Mohamed Gamal Abdelzaher
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Adel Abdelsalam
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Asmaa Farouk Enein
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Noha Abdelsalam
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Walha R, Dagenais P, Gaudreault N, Beaudoin-Côté G, Boissy P. The effects of custom-made foot orthoses on foot pain, foot function, gait function, and free-living walking activities in people with psoriatic arthritis (PsA): a pre-experimental trial. Arthritis Res Ther 2022; 24:124. [PMID: 35614481 PMCID: PMC9130455 DOI: 10.1186/s13075-022-02808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Foot involvement is a significant concern in psoriatic arthritis (PsA) as it can lead to severe levels of foot pain and disability and reduced mobility and quality of life. Previous studies have shown moderate efficacy for custom-made foot orthoses (CFO) in reducing foot pain and disability in people with rheumatoid arthritis. However, evidence on the efficacy of CFO in people with PsA is lacking. Objectives To explore the effects of CFO on foot function, foot and lower limb pain, gait function, and free-living walking activities (FWA) in people with PsA. Methods A pre-experimental study including twenty participants with PsA (mean age: 54.10 ± 9.06 years and disease duration: 11.53 ± 10.22 years) was carried out. All the participants received and wore CFO for 7 weeks. Foot and lower limb pain and foot function were measured before and after the intervention using the numerical rating scale (NRS) and the foot function index (FFI). Gait function was assessed by recording spatiotemporal parameters (STPs) during a 10-m walk test using an instrumented gait analysis system (Mobility Lab). Free-living walking activities (step count, free-living cadence, time spent in different ambulatory physical activities (APA)) were recorded over 7 days using an accelerometer-instrumented sock. Results The FFI reported scores demonstrated severe baseline levels of foot pain (54.46 ± 14.58 %) and disability (46.65 ± 16.14%). Statistically and clinically significant improvements in foot pain and foot function and large effect sizes (Cohen’s effect size > 1, p < 0.005) were observed after the intervention period. A strong correlation (r = −0.64, p < 0.01) between the CFO wearing time and foot function was demonstrated. However, no significant changes were found for gait STP or free-living walking activities after 7 weeks of CFO use. Conclusion Results support the clinical and biomechanical plausibility of using CFO in people with PsA to reduce pain and improve foot function. Large-scale and controlled studies are needed to confirm these findings. Moreover, a multidisciplinary approach including the prescription of exercise therapy and physiotherapy combined with CFO could be required to improve STP and promote APA in people with PsA. Trial registration ClinicalTrials.gov, NCT05075343. Retrospectively registered on September 29, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02808-8.
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Affiliation(s)
- Roua Walha
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Pierre Dagenais
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nathaly Gaudreault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Patrick Boissy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. .,Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada.
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Kaeley GS, Bakewell C, Deodhar A. The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Res Ther 2020; 22:1. [PMID: 31898524 PMCID: PMC6939339 DOI: 10.1186/s13075-019-2050-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/05/2019] [Indexed: 11/13/2022] Open
Abstract
Early differentiation between different types of inflammatory arthritis and subsequent initiation of modern treatments can improve patient outcomes by reducing disease activity and preventing joint damage. Routine clinical evaluation, laboratory testing, and radiographs are typically sufficient for differentiating between inflammatory and predominantly degenerative arthritis (e.g., osteoarthritis). However, in some patients with inflammatory arthritis, these techniques fail to accurately identify the type of early-stage disease. Further evaluation by ultrasound imaging can delineate the inflammatory arthritis phenotype present. Ultrasound is a noninvasive, cost-effective method that enables the evaluation of several joints at the same time, including functional assessments. Further, ultrasound can visualize pathophysiological changes such as synovitis, tenosynovitis, enthesitis, bone erosions, and crystal deposits at a subclinical level, which makes it an effective technique to identify and differentiate most common types of inflammatory arthritis. Limitations associated with ultrasound imaging should be considered for its use in the differentiation and diagnosis of inflammatory arthritides.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, 653-1 West 8th St., LRC 2nd Floor L-14, Jacksonville, FL, 32209, USA.
| | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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Fujikawa K, Kawashiri SY, Endo Y, Mizokami A, Tsukada T, Mine M, Uetani M, Kawakami A. Diagnostic efficacy of ultrasound detection of enthesitis in peripheral spondyloarthritis. Mod Rheumatol 2019; 30:1060-1066. [PMID: 31663417 DOI: 10.1080/14397595.2019.1687113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: We investigated the diagnostic efficacy of power Doppler ultrasound (PDUS) to detect enthesitis in Japanese patients with peripheral spondyloarthritis (SpA).Methods: This was a single-center cohort study of patients with peripheral symptoms suggestive of SpA. Articular synovia, tendons, and entheses were assessed by PDUS at baseline. Clinical, laboratory, and radiologic findings and classification criteria for SpA were also evaluated.Results: 136 patients were consecutively evaluated. A definite diagnosis was obtained in 111 patients, including 72 with SpA and 39 non-SpA. Among the patients with SpA, PDUS demonstrated articular synovitis in 40 of the 72 patients (56%), tenosynovitis or peritendinitis in 48 (67%), and enthesitis in 63 (88%). Considering PDUS alone, enthesitis in at least one site was the most useful means of differentiating SpA from non-SpA (sensitivity 87.5%; specificity 82.1%; accuracy 85.6%; positive likelihood ratio 4.88). Combining that finding along with fulfillment of Amor, European Spondyloarthropathy Study Group, or Assessment of SpondyloArthritis international Society criteria for peripheral SpA increased the specificity of the diagnosis (92.5%, 92.3%, and 97.4%, respectively).Conclusion: PDUS enthesitis is useful for the diagnosis of SpA with peripheral symptoms. Combining PDUS enthesitis with established SpA classification criteria is beneficial in diagnosing peripheral SpA.
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Affiliation(s)
- Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yushiro Endo
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan.,Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Toshiaki Tsukada
- Department of Rheumatology, Aino Memorial Hospital, Unzen, Japan
| | - Masanobu Mine
- Department of Rheumatology, Suga Orthopedic Hospital, Isahaya, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Affiliation(s)
- Aimie Patience
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Philip S. Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Heidi J. Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
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Toyota Y, Tamura M, Kirino Y, Sugiyama Y, Tsuchida N, Kunishita Y, Kishimoto D, Kamiyama R, Miura Y, Minegishi K, Yoshimi R, Ueda A, Nakajima H. Musculoskeletal ultrasonography delineates ankle symptoms in rheumatoid arthritis. Mod Rheumatol 2016; 27:425-429. [PMID: 27539651 DOI: 10.1080/14397595.2016.1222650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To clarify the use of musculoskeletal ultrasonography (US) of ankle joints in rheumatoid arthritis (RA). METHODS Consecutive RA patients with or without ankle symptoms participated in the study. The US, clinical examination (CE), and patients' visual analog scale for pain (pVAS) for ankles were assessed. Prevalence of tibiotalar joint synovitis and tenosynovitis were assessed by grayscale (GS) and power Doppler (PD) US using a semi-quantitative grading (0-3). The positive US and CE findings were defined as GS score ≥2 and/or PD score ≥1, and joint swelling and/or tenderness, respectively. Multivariate analysis with the generalized linear mixed model was performed by assigning ankle pVAS as a dependent variable. RESULTS Among a total of 120 ankles from 60 RA patients, positive ankle US findings were found in 21 (35.0%) patients. The concordance rate of CE and US was moderate (kappa 0.57). Of the 88 CE negative ankles, US detected positive findings in 9 (10.2%) joints. Multivariate analysis revealed that ankle US, clinical disease activity index, and foot Health Assessment Questionnaire, but not CE, was independently associated with ankle pVAS. CONCLUSION US examination is useful to illustrate RA ankle involvement, especially for patients who complain ankle pain but lack CE findings.
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Affiliation(s)
- Yukihiro Toyota
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Maasa Tamura
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Yohei Kirino
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Yumiko Sugiyama
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Naomi Tsuchida
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Yosuke Kunishita
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Daiga Kishimoto
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Reikou Kamiyama
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Yasushi Miura
- b Division of Orthopedic Science, Department of Rehabilitation Science , Kobe University Graduate School of Health Sciences , Kobe , Japan , and
| | - Kaoru Minegishi
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.,c Center for Rheumatic Diseases , Yokohama City University Medical Center , Yokohama , Japan
| | - Ryusuke Yoshimi
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Atsuhisa Ueda
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Hideaki Nakajima
- a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
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Gutierrez M, Pineda C, Salaffi F, Raffeiner B, Cazenave T, Martinez-Nava GA, Bertolazzi C, Vreju F, Inanc N, Villaman E, Delle Sedie A, Dal Pra F, Rosemffet M. Is ankle involvement underestimated in rheumatoid arthritis? Results of a multicenter ultrasound study. Clin Rheumatol 2016; 35:2669-78. [PMID: 27094944 DOI: 10.1007/s10067-016-3226-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/27/2016] [Accepted: 03/01/2016] [Indexed: 02/05/2023]
Abstract
The aim of this study is to investigate the prevalence of subclinical ankle involvement by ultrasound in patients with rheumatoid arthritis (RA). The study was conducted on 216 patients with RA and 200 healthy sex- and age-matched controls. Patients with no history or clinical evidence of ankle involvement underwent US examination. For each ankle, tibio-talar (TT) joint, tibialis anterior (TA) tendon, extensor halux (EH) and extensor common (EC) tendons, tibialis posterior (TP) tendon, flexor common (FC) tendon and flexor hallux (FH) tendon, peroneous brevis (PB) and longus (PL) tendons, Achilles tendon (AT) and plantar fascia (PF) were assessed. The following abnormalities were recorded: synovitis, tenosynovitis, bursitis, enthesopathy and rupture. BMI, DAS28, RF ESR and CRP were also obtained. A total of 432 ankles of patients with RA and 400 ankles of healthy controls were assessed. In 188 (87%) patients with RA, US showed ankle abnormalities whereas, in control group, US found abnormalities in 57 (28.5 %) subjects (p = 0.01). The most frequent US abnormality in RA patients was TP tenosynovits (69/216) (31.9 %), followed by PL tenosynovitis (58/216) (26.9 %), TT synovitis (54/216) (25 %), PB tenosynovitis (51/216) (23.6 %), AT enthesopathy (41/216) (19 %) and AT bursitis (22/216) (10.2 %). In 118 RA patients out of 216 (54.6%), a positive PD was found. No statistically significant correlation was found between the US findings and age, disease duration, BMI, DAS28, RF, ESR and CRP. The present study provides evidence of the higher prevalence of subclinical ankle involvement in RA patients than in age- and gender-matched healthy controls identified by US.
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Alsuwaidi M, Ehrenstein B, Fleck M, Hartung W. Asymptomatic Versus Symptomatic Ankle Joints in Rheumatoid Arthritis: A High-Resolution B-Mode and Power Doppler Ultrasound Study. Arthritis Care Res (Hoboken) 2015; 68:861-4. [PMID: 26414115 DOI: 10.1002/acr.22726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 07/20/2015] [Accepted: 09/08/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Ankle joints are frequently neglected in activity scoring systems, including the Disease Activity Score in 28 joints (DAS28). Only a few studies have assessed pathologies detected by ultrasonography of the ankles in symptomatic rheumatoid arthritis (RA) patients. We evaluated ankle joints in RA patients regardless of symptomatology, using musculoskeletal ultrasound (MSUS) as well as power Doppler ultrasound (PDUS). METHODS A total of 160 ankle joints of 80 RA patients were examined using MSUS and PDUS, according to the European League Against Rheumatism MSUS guidelines. Additionally, the talonavicular joints (TNJs) and the medial and the lateral tendon compartments were examined. The visual analog scale (VAS) score was recorded for each patient. RESULTS A total of 80 RA patients with a median age of 60 years and disease duration of 5 years were enrolled in our study. The median DAS28 score was 5. A total of 97 ankles were painful (VAS 1-10), whereas 63 ankles were asymptomatic (VAS 0). Overall, the predominant pathology was arthritis of the tibiotalar joint (TTJ) and/or TNJ in 124 ankles (77%), followed by tenosynovitis of the medial compartment tendons in 44 ankles (28%). Arthritis of the TTJ was present in 59% and synovitis of the TNJ in 35% of the symptomatic ankles. In asymptomatic ankles, TTJ synovitis was detected in 35%, whereas TNJ arthritis was observed in 18%. PDUS activity was higher in the subgroup of symptomatic ankles. CONCLUSION The most frequent pathologies detected by MSUS were arthritis of the TTJ and TNJ, followed by tenosynovitis of the medial compartment tendons. Pathologic findings were more frequent in symptomatic but also common in asymptomatic patients, whereas PDUS activity was generally low and mainly observed in symptomatic patients.
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