Ultrasound reliable for diagnosing ankle, foot involvement in RA

Ultrasound appears to be highly useful for evaluating various abnormalities in the ankle and foot area in patients with rheumatoid arthritis (RA), which can in turn aid in early diagnosis, prediction of functional disability, and proper management of ankle pathologies in RA, according to a study.

The study consisted of 152 newly diagnosed RA patients (mean age 43.23 years, 84.9 percent female, mean disease duration 1 month) and 52 healthy controls. All participants presented for history taking, clinical examination, and ultrasound scan.

At baseline, RA patients were receiving treatment with methotrexate, leflunomide, hydroxychloroquine, sulfasalazine, and steroids. None of them were on biological therapy and taking more than 10 mg of steroids per day or taking nonsteroidal anti-inflammatory drugs in the last 14 days.

According to the results of the ultrasound scan, ankle and foot pathologies were much more common among RA patients than among healthy controls. In the RA group, 200 ankles were symptomatic and 104 were asymptomatic. The median duration of ankle pain was 3 months, with a median pain score of 4 on a 0–9 visual analogue scale (VAS). The most common pathology was tibialis posterior (TP) tenosynovitis (45.4 percent), followed by tibiotalar (TTJ) synovitis (39.8 percent) and peroneal tenosynovitis (39.1 percent).

Furthermore, RA vs controls had fewer TTJ (p=0.001) foot pathologies, which, however, tended to worsen over time. On the other hand, TP (p=0.048) and peroneal tenosynovitis (p=0.011) were more frequently observed in early RA.

Multivariate analysis showed that TTJ, subtalar synovitis, forefoot pathologies, TP tenosynovitis, and Achilles enthesitis were significantly associated with functional disability. Meanwhile, the most important predictors of ankle pain were TTJ synovitis, TP tenosynovitis, peroneal tenosynovitis, and plantar fasciitis.

The present data suggest that ultrasound is a reliable tool for evaluating various abnormalities in the ankle region, allowing for better management.