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Ultrasound detected tenosynovitis in ankles of early RA patients
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Ultrasound frequently detected tenosynovitis, especially isolated tenosynovitis, in symptomatic ankles of patients with early rheumatoid arthritis, according to study results.
Researchers in Tokyo studied the consecutive records of 100 ankles in 74 patients with rheumatoid arthritis (RA; median age, 63.3 years; 52 women; median disease duration, 4.2 months) who had power Doppler ultrasound (PDUS) scans of symptomatic ankles. Ultrasound (US) findings and disease duration association was analyzed.
Fifty-six ankles displayed synovitis of the talar joints, including talocrural, subtalar and talonavicular joints. The medial recess in 46 ankles, the lateral recess in 29 ankles and anterior aspects in 10 ankles had ankle tenosynovitis. Thirty-nine ankles had Achilles’ tendon involvement including retrocalcaneal bursitis, Achilles’ tendon enthesitis, tendinitis and paratendinitis.
Ankles with tenosynovitis had a significantly shorter disease duration compared with ankles without tenosynovitis (11.4 ± 21.6 months vs. 32 ± 58.3 months; P=.039). In the 30 ankles with tenosynovitis but without joint synovitis (isolated tenosynovitis) disease duration had an even greater significance in shortness compared with all other ankles (5.9 ± 8.7 months vs. 25.2 ± 47.8 months; P=.0016). The ankles of patients with RA disease duration of less than 6 months displayed significantly more common tenosynovitis (P=.0357) and isolated tenosynovitis (P=.0236) than in the ankles of patients with established RA.
“Although it is generally thought that hindfoot involvement exhibiting deformity or radiological erosions develops in later stages in RA, it is not uncommon for early RA patients to present swelling or tenderness in the ankle area,” the researchers reported. “Although MRI is currently accepted as the gold standard, accessibility issues, including cost, prevent it from being widely used for examination of symptomatic ankles in RA. In contrast, US is extremely versatile.
“The use of US for the early diagnosis of RA should be encouraged, and scanning symptomatic ankles using PDUS from both medial and lateral aspects, as well as the anterior aspect, is likely to be of benefit.”
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