Abstract
To describe the prevalence and distribution of clinical and ultrasound (US) pathological findings at ankle level and to compare them, in patients with rheumatoid arthritis (RA). This is a descriptive, cross-sectional study assessing patients diagnosed with RA according to the 2010 ACR criteria, who were recruited consecutively and independently of disease status or treatment and of the presence of pain at ankle level. Clinical and US findings were acquired by two independent rheumatologists. US assessments were performed according to the EULAR and OMERACT indications. A total of 224 ankles of 112 RA patients were examined. One hundred (89.3%) patients were women and 12 (10.7%) were men, with a mean age of 51 years. RA mean disease duration was 72 months. Ankle spontaneous pain was found in 56.2% of the patients. In 65.2% of the patients, US found at least one pathologic sign indicative of joint and/or tendon pathology. Using grayscale US, joint involvement was more frequently found than tendon pathology (37.5% vs 22.3%). Conversely, no substantial difference was found between the prevalence of power Doppler signal at joint and tendon level. There was a significant correlation between clinical findings and US findings indicative of tibiotalar joint synovitis and peroneal tenosynovitis. In the present study, pain and US pathologic findings at ankle level were described and compared in a cohort of RA patients. Spontaneous pain was found in more than half of the patients and US found joint involvement more prevalent than tendon pathology.
References
Rao S, Riskowski J, Hannan MT (2012) Musculoskeletal conditions of the foot and ankle: assessment and treatment option. Best Pract Res Clin Rheumatol 26:345–368
Matsumoto T, Nakamura I, Miura A, Mmoyama G, Ito K (2014) Radiologic patterning of joint damage to the foot in rheumatoid arthritis. Arthritis Care Res 66:499–507
Frizziero A, Bonsangue V, Trevison M, Ames PRJ, Masiero S (2013) Foot tendinopathies in rheumatic diseases: etiopathogenesis, clinical manifestations and therapeutic options. Clin Rheumatol 32:547–555
de Souza S, Williams R, Lempo H (2016) Patient and clinical views on the quality of foot health care for rheumatoid arthritis outpatients: a mixed methods service evaluation. J Foot Ankle Res 9:1
D’Agostino MA, Ayral X, Baron G, Ravaud P, Breban M, Dougados M (2005) Impact of ultrasound imaging on local corticosteroid injections of symptomatic ankle, hind-, and mid-foot in chronic inflammatory diseases. Arthritis Rheum 15:284–292
Suzuki T, Tohda E, Ishihara K (2009) Power Doppler ultrasonography of symptomatic rheumatoid arthritis ankles revealed a positive association between tenosynovitis and rheumatoid factor. Mod Rheumatol 19:235–244
Luukkainen R, Ekman P, Luukkainen P, Koski JM (2009) Ultrasonographic findings in metatarsophalangeal and talocrural joints in healthy persons. Clin Rheumatol 28:311–313
Micu M, Serra S, Fodor D, Crespo D, Naredo E (2011) Inter-observer reliability of ultrasound detection of tendon abnormalities at the wrist and ankle in patients with rheumatoid arthritis. Rheumatology 50:1120–1124
Wakefield RJ, Freeston JE, O’Connor P, Reay N, Budgen A, Hensor EM et al (2008) The optimal assessment of the rheumatoid arthritis hindfoot: a comparative study of clinical examination, ultrasound and high field MRI. Ann Rheum Dis 67:1678–1682
Grassi W, Cervini C (1998) Ultrasonography in rheumatology: an evolving technique. Ann Rheum Dis 57:268–271
Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A (2005) Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 64:375–381
Weidekamm C, Köller M, Weber M, Kainberger F (2003) Diagnostic value of high resolution B-Mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum 48:325–333
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324
Klippel JH, Dieppe PA (1988) The ankle and foot. In: Rheumatology, chapter 12.1. Second edition. Mosby. UK
Möller I, Janta I, Backhaus M, Ohrndorf S, Bong DA, Martinoli C, Filippucci E, Sconfienza LM, Terslev L, Damjanov N, Hammer HB, Sudol-Szopinska I, Grassi W, Balint P, Bruyn GAW, D’Agostino MA, Hollander D, Siddle HJ, Supp G, Schmidt WA, Iagnocco A, Koski J, Kane D, Fodor D, Bruns A, Mandl P, Kaeley GS, Micu M, Ho C, Vlad V, Chávez-López M, Filippou G, Cerón CE, Nestorova R, Quintero M, Wakefield R, Carmona L, Naredo E (2017) The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology. Ann Rheum Dis 76:1974–1979
Torp-Pedersen ST, Terslev L (2008) Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis 67:143–149
Wakefield RJ, Balint P, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487
Filippucci E, Iagnocco AM, Meenagh G, Riente L, Delle Siede A, Bombardieri S et al (2007) Ultrasound imaging for the rheumatologist VII. Ultrasound imaging in rheumatoid arthritis. Clin Exp Rheumatol 25:5–10
Bruyn GA, Hanova P, Iagnocco A, D’Agostino MA, Möller I, Terslev L, Backhaus M et al (2014) Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focusing on the diagnostic reliability. Ann Rheum Dis 73:1929–1934
Naredo E, D’Agostino MA, Wakefield RJ, Möller I, Balint PV, Filippucci E, Iagnocco A, Karim Z, Terslev L, Bong DA, Garrido J, Martínez-Hernández D, Bruyn GAW, on behalf of the OMERACT Ultrasound Task Force* (2013) Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 72:1328–1334
Suzuki T, Okamoto A (2013) Ultrasound examination of symptomatic ankles in shorter-duration rheumatoid arthritis patients often reveals tenosynovitis. Clin Exp Rheumatol 31:281–284
Elsaman AM, Mostafa ES, Radwan AR (2017) Ankle evaluation in active rheumatoid arthritis by ultrasound: a cross-sectional study. Ultrasound Med Biol 43:2806–2813
Gutierrez M, Pineda C, Salaffi F, Raffeiner B, Cazanave T, Martínez-Nava GA, Bertolazzi C et al (2016) Is ankle involvement underestimated in rheumatoid arthritis? Results of a multicenter ultrasound study. Clin Rheumatol 35:2669–2678
Micu MC, Serra S, Fodor D, Crespo M, Naredo E (2011) Interobserver reliability of ultrasound detection of tendon abnormalities at the wrist and ankle in patients with rheumatoid arthritis. Rheumatology 50:1120–1124
Hammer HB, Kvien TK (2011) Ultrasonography shows significant improvement in wrist and ankle tenosynovitis in rheumatoid arthritis patients treated with adalimumab. Scand J Rheumatol 40:178–182
Harman H, Tekeoğlu İ (2017) Ankle pathologies in patients with inflammatory rheumatic diseases: a clinical and ultrasonographic study. Int J Rheum Dis 20:675–684
Janta I, Stanciu D, Hinojosa M, Nieto-González JC, Valor L, Bello N, Serrano B, Mata-Martínez C, Martínez-Barrio J, Ovalles-Bonilla JG, González CM, López-Longo FJ, Monteagudo I, Naredo E, Carreño L (2016) Structural damage in rheumatoid arthritis: comparison between tendon damage evaluated by ultrasound and radiographic damage. Rheumatology 55:1042–1046
Alsuwaidi M, Ehrenstein B, Fleck M, Hartung W (2016) Asymptomatic versus symptomatic ankle joints in rheumatoid arthritis. A high resolution B-Mode and power Doppler ultrasound study. Arthritis Care Res 68(6):861–864
Toyota Y, Tamura M, Kirino Y, Sugiyama Y, Tsuchida N, Kunishita Y, Kishimoto D, Kamiyama R, Miura Y, Minegishi K, Yoshimi R, Ueda A, Nakajima H (2017) Musculoskeletal ultrasonography delineates ankle symptoms in rheumatoid arthritis. Mod Rheumatol 27:425–429
Naredo E, Valor L, De la Torre I, Martínez-Barrio J, Hinojosa M, Aramburu F et al (2013) Ultrasound joint inflammation in rheumatoid arthritis in clinical remission: how many and which joints should be assessed? Arthritis Care Res 65:512–517
Torp-Pedersen S, Christensen R, Szkudlarek M, Ellegaard K, D’Agostino MA, Iagnocco A, Naredo E, Balint P, Wakefield RJ, Torp-Pedersen A, Terslev L (2015) Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis. Arthritis Rheum 67:386–395
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All the authors declare no conflict of interest for this manuscript.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hernández-Díaz, C., Sánchez-Bringas, G., Ventura-Ríos, L. et al. Ankle pain in rheumatoid arthritis: comparison of clinical and sonographic findings. Clin Rheumatol 38, 2891–2895 (2019). https://doi.org/10.1007/s10067-019-04532-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-019-04532-2