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

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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.

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Authors and Affiliations

  1. Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, CP 143898, Mexico City, Mexico

    Marwin Gutierrez, Carlos Pineda, Gabriela A. Martinez-Nava & Chiara Bertolazzi

  2. Clinica Reumatologica, Universita Politecnica delle Marche, Jesi, Ancona, Italy

    Marwin Gutierrez & Fausto Salaffi

  3. Department of Medicine, Rheumatology Unit, Ospedale di Bolzano, Italy

    Bernd Raffeiner

  4. Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina

    Tomas Cazenave, Fernando Dal Pra & Marcos Rosemffet

  5. Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania

    Florentin Vreju

  6. Rheumatology Department, Marmara University, Istanbul, Turkey

    Nevsun Inanc

  7. Research Department, Universidad Autónoma de Baja California, Mexicali, Mexico

    Eduardo Villaman

  8. Rheumatology Department, University of Pisa, Pisa, Italy

    Andrea Delle Sedie

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  1. Marwin Gutierrez
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  2. Carlos Pineda
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Correspondence to Marwin Gutierrez.

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Authors’ contributions

MG participated in the design of the study and the acquisition and interpretation of data, and performed the drafting of the manuscript. BR, TC, FV, NI, EV, AdS, FDP participated in data acquisition and performed the US examinations. CP, FS made substantial contributions to the conception and design of the study, participated in the acquisition of data and was involved in revising the manuscript for important intellectual content. GMN performed the statistical analysis and was involved in revising the manuscript for intellectual content MR participated in the conception of the study and data interpretation, was involved in drafting the manuscript, and gave final approval of the version of the paper to be published. All authors read and approved the final manuscript.

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Proportion of patients according the possible combination of treatments. (DOC 30 kb)

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Gutierrez, M., Pineda, C., Salaffi, F. et al. Is ankle involvement underestimated in rheumatoid arthritis? Results of a multicenter ultrasound study. Clin Rheumatol 35, 2669–2678 (2016). https://doi.org/10.1007/s10067-016-3226-9

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