Ankle and foot pathologies in early rheumatoid arthritis, what can ultrasound tell us?

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.

Role of High-Resolution Grey Scale and Power Doppler Ultrasonography in Assessment of Ankle Joints of Symptomatic and Asymptomatic Rheumatoid Arthritis Patients

“…Confirming our results, a study reported that BMI in patients with low DAS 28 was substantially lower than moderate DAS 28 participants [17] . Interestingly, a research indicated that US-observed ankle inflammation was substantially associated with RA activity.…”

“…In the present work, of the study participants, 38 (38%) participants had no symptoms, and 62 (62%) had symptoms, of them 9 (9%) participants were in right ankle, 15 (15%) participants were in left ankle, and 38 (38%) bilateral. Supporting our results, a study reported symptoms with 200 ankles 104 were without symptoms [17] . Parallel to our results, a study reported total of 97 painful ankles, while 63 ankles had no symptoms [19] .…”

“…A recent study reported that the DAS-28 score extended between 1.2 and 5.8 with an average value of 3.8, ESR ranged from 5 to 125 mm/h with a median value of 46.5 mm/h [17] . Similarly, another study reported that the RA mean disease duration was 72 months [18] .…”

“…Foot function index and a health evaluation questionnaire were used to examine the effect on health. They reported that the patients had a mean age of 43.23 (SD 12.5) years, with a greater proportion of female (84.9%) than male (15.1%) [17] .…”