SAT0644 Is ankle involvement important in rheumatoid arthritis?

Abstract

BackgroundThe ankles may be affected by rheumatoid arthritis (RA). In daily evaluation of RA patients, the ankles are often neglected by clinical examinations, while composite activity scores do not include themObjectivesThe aim of the study is to assess the inflammatory lesions in RA ankles, regarding frequency and possible correlation with activity diseaseMethodsThe study included 76 RA patients fulfilling the 2010 ACR/EULAR classification criteria. In every patient we recorded clinical ankle involvement (ankle swelling and/or tenderness on physical examination); both ankles were evaluated by gray scale (GS) and Power Doppler (PD) ultrasound examination, graded from 0–3. In each joint we assessed: tibio-talar joint (TT); tibialis anterior (TA) tendon; extensor hallux (EH) and extensor digitorum (ED) tendons; talo-navicular joint (TN); tibialis posterior (TP) tendon; flexor digitorum (FD) and flexor hallux (FH) tendons; peroneus brevis (PB) and longus (PL) tendons; Achilles tendon (AT); subtalar joints (SJ; posterior, lateral, medial recesses); plantar fascia (PL). We recorded the following abnormalities: synovitis, tenosynovitis, bursitis, entesopathy and rupture. Activity scores (DAS28, DAS44, SDAI), inflammatory markers (ESR, CRP), serology (FR, ACPA) and HAQ were also assessedResultsThe mean age was 57.2±14.2 years; 88% were women; mean disease duration was 12.2±9.2 years; 56.6% had symptomatic ankles; 81.6% had ultrasound ankle abnormalities. The most frequent ultrasound pathology encountered was ST synovitis (56.6%), followed by TT synovitis (48.7%), TN synovitis (38.2%), TP tenosynovitis (30.3%), PL tenosynovitis (15.8%). Ultrasound abnormalities were recorded in 93% of the symptomatic ankle patients and in 66.7% of the asymptomatic ankle patients (p=0.008). Overall, 43% had positive PD signals, but the prevalence of positive PD signals was significantly higher in symptomatic ankle patients than in asymptomatic ankle patients (60.5% compared to 21.2%, p=0.011). Statistically significant correlations were found between ultrasound inflammatory pathology (synovitis and tenosynovitis), activity disease markers and quality of life (Table 1).Table 1.Correlations of GS ultrasound measures with disease activity and HAQESRCRPDAS28CRP DAS28ESR DAS44SDAIHAQ TT0.1040,360**0,395***0,283*0,317**0,352**0.150TN0.1590,426***0,442***0,330**0,366**0,391***0.007PL0.272*0.366**0.368**0.347**0.362**0.340**0,292*PB0.0740.1390.2000.2150.231*0.2230,243*TP0.408***0.466***0.543***0.548***0.558***0.542***0,268*FD0.1660.1450.254*0.260*0.285*0.259*0,256*Note: the reported values represent the rho coefficients of bivariate Spearman correlations: *p<0,05; **p<0,01; ***p<0,001.ConclusionsMusculoskeletal ultrasound detected a high prevalence of inflammatory abnormalities in rheumatoid arthritis ankles, in both symptomatic and asymptomatic patients, while power Doppler signal was present mostly in symptomatic patients. The ultrasound pathology was highly correlated with activity disease markers and quality of lifeReferences M Backhaus, G-R...

Musculoskeletal Ultrasound in Rheumatological Diseases

“…MSK US is also a valuable instrument for directing invasive surgeries. It allows for accurate and exact needle placement and is a safe technique for patients requiring synovial fluid aspiration, injectable treatment, and/or biopsy [8,9,10,11,12].…”

“…Each anatomical region should be investigated on many scan planes in order to collect all relevant data. An in-depth understanding of anatomy is necessary for MSK US" [10].…”