Power Doppler ultrasonography of symptomatic rheumatoid arthritis ankles revealed a positive association between tenosynovitis and rheumatoid factor

Abstract

The aim of this study was to characterize the pathological conditions of symptomatic ankles in patients with rheumatoid arthritis (RA) using power Doppler sonography (PDS). We analyzed 17 consecutive ultrasonography (US) records of RA patients with symptomatic ankles who underwent B-mode ultrasonography (BUS) combined with PDS of their ankles in our department because of clinical need. Correlations between US findings and clinical and serological data were assessed. The diagnostic capabilities of BUS and PDS were also compared. Common US findings were talocrural synovitis (76%), subtalar synovitis (71%), and talonavicular synovitis (59%). Tenosynovitis around the ankle was detected in ten patients (59%), including several cases of tenosynovitis of tibialis posterior (41%) and tenosynovitis of peroneus longus and brevis (35%). Achilles tendon enthesitis was detected in six patients, and retrocalcaneal bursitis was detected in five. Compared with BUS, PDS offers demonstrably superior diagnostic capability for the detection of rheumatoid ankle diseases, especially subtalar joint synovitis and peroneal tenosynovitis. Rheumatoid factor (RF) levels were significantly higher in patients with tenosynovitis than in patients without tenosynovitis. PDS is an excellent modality for diagnosing both intra- and extracapsular synovitis in rheumatoid ankles. Using PDS, we found positive association between ankle tenosynovitis and RF levels in RA patients.

Concepts in diagnosing, scoring, and monitoring tenosynovitis and other tendon abnormalities in patients with rheumatoid arthritis- the role of musculoskeletal ultrasound.

“…Moreover, MSUS has been considered by some authors as the "goldstandard" method for the evaluation of superficial tendons [45]. In comparison to MRI it permits not only multi-planar evaluation but also real time dynamic assessment and vasculariza-Overall, MSUS showed a fair to moderate sensitivity but a high specificity [28,29,31,33,37,46,[60][61][62][63][64][65][66][67][68][69][70][71][72].…”

Usefulness of ultrasonography-proven tenosynovitis to monitor disease activity of a patient with very early rheumatoid arthritis treated by abatacept

“…Although knowledge is limited regarding the response of tenosynovitis to anti-inflammatory treatment, a recent report revealed that the PD tenosynovitis score of RA patients was also improved by adalimumab [8]. Another report found a positive association between tenosynovitis of the ankle joints and RF [17], suggesting that we should Fig. 2 Clinical course of the present case.…”

Using ultrasound to image the foot in rheumatoid arthritis: current understanding, challenges and future scope

“…Others have since argued the advantages for the use of US for imaging of the midfoot and rearfoot [52]. In patients with RA, US has been useful to image tenosynovitis, especially within the foot and ankle tendons [5,[53][54][55][56][57][58]. In a small study of patients with established RA, US demonstrated good correlation with MRI for identifying hindfoot pathology [11].…”