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

Abstract

Objectives To evaluate the ankle, hindfoot, and heel changes (determined by physical examination, ultrasound and baropodometry) in patients with rheumatoid arthritis, to compare the findings with healthy subjects, and to analyze if these findings are associated with ankle pain and could affect the quality of life. Methods We enrolled 35 rheumatoid arthritis patients and 35 healthy controls, and evaluated their ankles (tibiotalar joints, tendons), hindfeet (talonavicular, subtalar joints) and heels using clinical examination, DAS28-CRP, RAPID3 for the evaluation of functional status, quality of life in rheumatoid arthritis questionnaire, ultrasound, and baropodometry. Results The ultrasound inter-observer agreement was good for the subtalar joint, and very good for the other structures. Flat foot was identified in 50% of feet in rheumatoid arthritis patients, with 83.8% having concomitant hindfoot valgus and less subtalar joint synovitis visible from the lateral approach (32.4% vs 55.6%, p = 0.041). The body mass index, RAPID3 and subtalar synovitis were independent predictors for the symptomatic ankle (all p <0.05). Midfoot and heel plantar pressures were higher in rheumatoid arthritis patients compared to healthy controls, but when subtalar synovitis was present, the pressures decreased (avoidance of heel support). Poor quality of life in rheumatoid arthritis patients was independently predicted by DAS28-CRP, RAPID3, disease stage, hindfoot valgus, tibiotalar and subtalar synovitis, tendon pathology, Achilles tendon enthesophytes, calcaneal erosions, plantar fasciitis, and perifasciitis (all p <0.05). Conclusion The quality of life of rheumatoid arthritis patients is significantly affected by ankle and hindfoot pathology (inflammatory modifications, but also degenerative findings and deformities). Ultrasound scanning is an important tool in the evaluation of inflammatory and degenerative lesions in these regions, and their early detection might contribute to a better therapeutic management in these patients.

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

“…Our findings revealed a statistically significant link between ankle pathologies and higher Health assessment questionnaire and FFI scores. Our findings were consistent with those of Serban et al, 18 Harman and Tekeoğlu, 15 and Jeong et al, 26 who highlighted the association between hindfoot pathologies and functional disability. Our findings differ from those of Petterle et al 27 This may be explained by their examination of only asymptomatic feet, whereas our sample size included both symptomatic and asymptomatic feet.…”

“…At the heel, important sites must be evaluated: the Achilles tendon, retrocalcaneal bursa, as well as the adjacent cortical surface of the calcaneum. 17 Our findings showed the presence of retrocalcaneal bursitis with positive PD, and this matches with Serban et al, 18 who stated that retrocalcaneal bursa had a significant impact on patients' symptomatology and quality of life.…”

“…In one study, age, disease duration, and disease activity were found to be predictors of hindfoot valgus. 18 STJ, TP, and peroneal tenosynovitis were discovered to be predictors of FFI in another study. 15 We investigated more data, supported by our large sample size, and discovered TTJ, STJ, forefoot synovitis, TP tenosynovitis, and Achilles enthesitis to be predictors of impaired ankle and foot function.…”

The Onset of Subtalar Joint Monoarthritis in a Patient with Rheumatoid Arthritis

“…Șerban et al found that the quality of life (QoL) of patients with RA is significantly affected due to ankle and hindfoot pathology, including tibiotalar synovitis, subtalar synovitis, tibialis posterior tenosynovitis/tendinosis, and peroneal tendinosis. Inflammation, as well as degeneration and deformities, were diagnosed [ 6 ]. Tibialis posterior tendon involvement on MRI was frequently observed in those patients with RA presenting with tarsal inflammation [ 7 ].…”

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

“…The added value of US in detecting inflammatory lesions [176,179,180] is proven, showing the importance of the method in characterizing disease activity. In the ankle and midfoot, the tibiotarsal (TT) and talonavicular joints are the most frequently affected joints [181][182][183][184] while in the forefoot the metatarsophalangeal (MTP) joints, especially MTP II-V, are most affected [183,185]. Using US, subclinical synovitis was found in 25 % of RA patients in clinical remission [186] and the presence of the power Doppler signal in MTP joints showed predictive value for unstable remission [186] and radiographic progression [187].…”