The relevance of ultrasound examination of the foot and ankle in patients with rheumatoid arthritis – a review of the literature

Abstract

Rheumatoid arthritis (RA) is an inflammatory disease characterized by symmetrical involvement of the joints and tendons, especially of the hands and wrists, but also of the feet and ankles from the very beginning of the disease. For the patient, the foot and ankle involvement is equally important as the other joints, since it affects the functionality of the feet and the quality of life of the patients. It is already known that subclinical involvement of the ankles and feet occurs even in patients that are considered in clinical remission, thus they do not need for changes of therapy, but still might benefit from it. In spite of this, the clinicians do not give enough care to the ankle and foot in RA patients, especially if asymptomatic, resulting future deformities, joint damage and feet disability. In order to show the importance of the feet and ankles in RA patients and to demonstrate the indispensable role of ultrasonography (US) for that purpose, at the same time displaying the US abnormalities that should draw our attention, we performed this review of the literature.

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

“…We note the low incidence of PD in the ankle joints, which can be explained by the low sensitivity of PD for large joints and deep anatomic areas. The same low PD frequency in TTJ was also noted by other authors [13,34,38,39], who proposed to further scan the lateral and medial aspects of TTJ's anterior recess in order to increase PD sensitivity. Regarding STJ, PD signals were detected only in the medial and lateral recesses.…”

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

“…Ultrasonography (US) is considered to be superior to clinical examination in the detection of synovitis, and its contribution to detecting damage from the early stages, evaluating the therapeutic response, monitoring disease activity or assessing persistent inflammation has been underlined in the European League Against Rheumatism (EULAR) recommendations ( 15 ) . However, as we previously noted in our systematic review ( 16 ) , only few studies have been published on US findings for ankle and hindfoot in RA patients. Only one study has explored links between US-detected synovitis (subclinical) of the foot and ankle, and poor QoL and functional status ( 17 ) .…”

High-Resolution Ultrasound of the Forefoot and Common Pathologies

“…Synovial hypertrophy and effusion, bone erosion and tenosynovitis often occur in RA patients, especially in the hands and wrists, but also in the feet and ankles. Synovitis (synovial hypertrophy and power Doppler signal) at the MTP joints can often be detected in RA patients who have a total power Doppler (PD) score of ≥5 in the hand and is most often observed at the second to fourth MTP joints [ 28 , 29 ]. Gout commonly affects the first MTP joint and causes acute pain, swelling, and redness around the joint [ 30 , 31 ].…”