Ankle involvement in rheumatoid arthritis – a comparison of inflammatory signs on musculoskeletal ultrasound and magnetic resonance imaging

Abstract

Aim: To evaluate the frequency of tibiotalar and subtalar joints together with extensor, flexor and peroneal tendons inflammatory lesions in rheumatoid arthritis (RA) patients by using ultrasound (US) and magnetic resonance imaging (MRI).Material and methods. Fifty RA patients and 25 healthy subjects were prospectively included. All patients and controlsunderwent clinical examination (to screen for swollen and/or tender ankles) and ankle US and MRI (to screen for synovialhypertrophy – SH, tenosynovitis and power Doppler – PD signals). The imaging tests were compared using overall agreement, positive agreement, Cohen’s κ, sensitivity, specificity and positive likelihood ratio.Results. The subtalar joint had the highest frequency of US-detected SH (30%), as well as positive PD signals (10%). Regarding US joint effusion, the tibiotalar joint recorded the highest frequency (44%). The most frequent US tenosynovitis was detected in the tibialis posterior tendon (40%). Compared to MRI, US evaluation of tibiotalar joints had very good agreement and large effect on detection probability for both SH and effusion (kappa 0.84, positive likelihood ratio 21.1). Compared to MRI, the sensitivity and specificity for US joint involvement ranged between 72.0-88.5% and 82.4-95.8%, and for tenosynovitis were 33.3-78.6% and 85.2-100%, respectively. Compared to asymptomatic RA patients (n=25), those with at least one symptomatic ankle (n=25) had significantly higher frequencies of both SH and effusion in all the evaluated structures.Conclusion: US has high sensitivity and specificity in detecting RA inflammatory lesions in the ankle and rearfoot, in very good agreement with MRI. The high frequency of ankle inflammatory lesions in RA should result in increased interest in the imaging evaluation of these structures.

Do ankle, hindfoot, and heel ultrasound findings predict the symptomatology and quality of life in rheumatoid arthritis patients?

“…This might explain why we found less ST synovitis visible from the lateral approach in patients with hindfoot valgus. The presence of synovitis could be an important source of pain ( 34 , 35 ) , and probably for this reason the patients had modified walking/standing heel pressure by avoiding heel support (we found that the pressure on the anterior foot in these patients was increased, data not shown). In a 20-year follow-up study, Belt et al .…”

Knee alterations in rheumatoid arthritis: Comparison of US and MRI

“…A study conducted in 2019 reported that US is an accurate and reliable tool in detecting shoulder pathologies [ 20 ]. Luminița and his colleagues provided the same conclusion about the ankle [ 21 ]. Thus, US may play an important role in the initial imaging modality of the knee in patients with RA.…”

SWE and SMI ultrasound techniques for monitoring needling treatment of ankylosing spondylitis: study protocol for a single-blinded randomized controlled trial

“…Although musculoskeletal ultrasound is less sensitive than MRI and X-ray in early detection of synovitis and tenosynovitis [ 24 ], it is suitable for short-term evaluation of stable rheumatic diseases, offering highly accessible, low-cost, real-time imaging without radiation [ 25 , 26 ]. The OMERACT Ultrasound Working Group has engaged in the validation of ultrasound as an outcome measurement instrument (OMI) by defining ultrasound manifestations of spondyloarthritis (SpA) [ 27 ].…”