Clinical Rheumatology

, Volume 35, Issue 11, pp 2669–2678 | Cite as

Is ankle involvement underestimated in rheumatoid arthritis? Results of a multicenter ultrasound study

  • Marwin Gutierrez
  • Carlos Pineda
  • Fausto Salaffi
  • Bernd Raffeiner
  • Tomas Cazenave
  • Gabriela A. Martinez-Nava
  • Chiara Bertolazzi
  • Florentin Vreju
  • Nevsun Inanc
  • Eduardo Villaman
  • Andrea Delle Sedie
  • Fernando Dal Pra
  • Marcos Rosemffet
Original Article

Abstract

The aim of this study is to investigate the prevalence of subclinical ankle involvement by ultrasound in patients with rheumatoid arthritis (RA). The study was conducted on 216 patients with RA and 200 healthy sex- and age-matched controls. Patients with no history or clinical evidence of ankle involvement underwent US examination. For each ankle, tibio-talar (TT) joint, tibialis anterior (TA) tendon, extensor halux (EH) and extensor common (EC) tendons, tibialis posterior (TP) tendon, flexor common (FC) tendon and flexor hallux (FH) tendon, peroneous brevis (PB) and longus (PL) tendons, Achilles tendon (AT) and plantar fascia (PF) were assessed. The following abnormalities were recorded: synovitis, tenosynovitis, bursitis, enthesopathy and rupture. BMI, DAS28, RF ESR and CRP were also obtained. A total of 432 ankles of patients with RA and 400 ankles of healthy controls were assessed. In 188 (87%) patients with RA, US showed ankle abnormalities whereas, in control group, US found abnormalities in 57 (28.5 %) subjects (p = 0.01). The most frequent US abnormality in RA patients was TP tenosynovits (69/216) (31.9 %), followed by PL tenosynovitis (58/216) (26.9 %), TT synovitis (54/216) (25 %), PB tenosynovitis (51/216) (23.6 %), AT enthesopathy (41/216) (19 %) and AT bursitis (22/216) (10.2 %). In 118 RA patients out of 216 (54.6%), a positive PD was found. No statistically significant correlation was found between the US findings and age, disease duration, BMI, DAS28, RF, ESR and CRP. The present study provides evidence of the higher prevalence of subclinical ankle involvement in RA patients than in age- and gender-matched healthy controls identified by US.

Keywords

Ankle Rheumatoid arthritis Subclinical involvement Ultrasound 

Supplementary material

10067_2016_3226_MOESM1_ESM.doc (30 kb)
ESM 1Proportion of patients according the possible combination of treatments. (DOC 30 kb)

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2016

Authors and Affiliations

  • Marwin Gutierrez
    • 1
    • 2
  • Carlos Pineda
    • 1
  • Fausto Salaffi
    • 2
  • Bernd Raffeiner
    • 3
  • Tomas Cazenave
    • 4
  • Gabriela A. Martinez-Nava
    • 1
  • Chiara Bertolazzi
    • 1
  • Florentin Vreju
    • 5
  • Nevsun Inanc
    • 6
  • Eduardo Villaman
    • 7
  • Andrea Delle Sedie
    • 8
  • Fernando Dal Pra
    • 4
  • Marcos Rosemffet
    • 4
  1. 1.Division of Musculoskeletal and Rheumatic DiseasesInstituto Nacional de RehabilitaciónMexico CityMexico
  2. 2.Clinica ReumatologicaUniversita Politecnica delle MarcheAnconaItaly
  3. 3.Department of MedicineRheumatology UnitOspedale di BolzanoItaly
  4. 4.Instituto de Rehabilitación PsicofísicaBuenos AiresArgentina
  5. 5.Rheumatology DepartmentUniversity of Medicine and Pharmacy CraiovaCraiovaRomania
  6. 6.Rheumatology DepartmentMarmara UniversityIstanbulTurkey
  7. 7.Research DepartmentUniversidad Autónoma de Baja CaliforniaMexicaliMexico
  8. 8.Rheumatology DepartmentUniversity of PisaPisaItaly

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