Gutierrez Marwin, Pineda Carlos, Salaffi Fausto, Raffeiner Bernd, Cazenave Tomas, Martinez-Nava Gabriela A, Bertolazzi Chiara, Vreju Florentin, Inanc Nevsun, Villaman Eduardo, Delle Sedie Andrea, Dal Pra Fernando, Rosemffet Marcos
Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, CP 143898, Mexico City, Mexico.
Clinica Reumatologica, Universita Politecnica delle Marche, Jesi, Ancona, Italy.
Clin Rheumatol. 2016 Nov;35(11):2669-2678. doi: 10.1007/s10067-016-3226-9. Epub 2016 Apr 19.
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.
本研究旨在调查类风湿关节炎（RA）患者中超声检查发现的亚临床踝关节受累情况。该研究对216例RA患者和200例年龄及性别匹配的健康对照者进行。无踝关节受累病史或临床证据的患者接受超声检查。对每个踝关节的胫距（TT）关节、胫前（TA）肌腱、拇长伸肌（EH）和趾长伸肌（EC）肌腱、胫后（TP）肌腱、趾长屈肌（FC）肌腱和拇长屈肌（FH）肌腱、腓骨短肌（PB）和腓骨长肌（PL）肌腱、跟腱（AT）和足底筋膜（PF）进行评估。记录以下异常情况：滑膜炎、腱鞘炎、滑囊炎、附着点病和破裂。同时获取体重指数（BMI）、疾病活动度评分（DAS28）、类风湿因子（RF）、红细胞沉降率（ESR）和C反应蛋白（CRP）。共评估了RA患者的432个踝关节和健康对照者的400个踝关节。在188例（87%）RA患者中，超声显示踝关节异常，而在对照组中，超声在57例（28.5%）受试者中发现异常（p = 0.01）。RA患者中最常见的超声异常是TP腱鞘炎（69/216）（31.9%），其次是PL腱鞘炎（58/216）（26.9%）、TT滑膜炎（54/216）（25%）、PB腱鞘炎（51/216）（23.6%）、AT附着点病（41/216）（19%）和AT滑囊炎（22/216）（10.2%）。在216例RA患者中的118例（54.6%）中发现阳性点彩（PD）。超声检查结果与年龄、病程、BMI、DAS28、RF、ESR和CRP之间未发现统计学上的显著相关性。本研究提供了证据，证明RA患者中亚临床踝关节受累的患病率高于通过超声确定的年龄和性别匹配的健康对照者。
