gms | German Medical Science

Background: As weight bearing joints the ankle joints play a substantial role for patients mobility, nevertheless they are historically neglected by the DAS 28 scoring system. However only few studies have assessed US detected pathologies of the ankle in symptomatic RA patients [1]. Therefore the aim of this study was to characterize the type and degree of involvement of ankle joints in established RA patients regardless of symptomatology or duration of illness utilizing standardized high resolution musculoskeletal ultrasound (MSUS) including colour Doppler ultrasonography (CDUS).

Methods: A total number of 89 ankle joints of 45 consecutive patients with RA fulfilling the ACR/EULAR classification criteria 2010 were examined using MSUS (Logic E9, GE Healthcare, Buckinghamshire, GB with a ML6-15 linear probe with 6- 15 MHz) and CDUS according to the EULAR MSUS guidelines [2]. Additionally to the recommended scanning planes the talonavicular, the intertarsal- and the tarso-metatarsal joints were investigated. For each patient ankle pain (VAS score 0-10) and loss of function was documented.

Results: 45 RA patients (32 female, 13 male) with a median age of 61 years (range 28–81) and a disease duration of 5 years ( 0–43 range) were enrolled in our study. The median DAS28 was 5,0 (range 0,8–7,8). 27of them suffered from ankle pain, whereas 18 were completely asymptomatic according the ankles. Overall the predominant pathology was arthritis of the tibiotalar and /or talonaviclar joint in 64% (29 out of 45) followed by tenosynovitis of the flexor tendons in 44% (20 out of 45). 85% (23/27) of the symptomatic patients revealed pathologic B-mode findings, however also 61% (11/18) in the asymptomatic subgroup as well. In contrast CDUS activity was higher in the symptomatic group with 33% (9/27) compared to 17% (3/18) of the asymptomatic patients (for detailed information s. Table 1 [Tab. 1]).

Conclusion: Most frequent pathologies detected were arthritis of the tibiotalar and talonavicular joint, followed by tenosynovitis of the flexor tendons. Pathologic findings are also common in asymptomatic patients with RA, whereas CDUS activity is predominately seen in symptomatic patients.