Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany.
Int J Rheum Dis. 2022 Nov;25(11):1315-1323. doi: 10.1111/1756-185X.14426. Epub 2022 Aug 26.
Rheumatoid arthritis (RA) is a systemic autoimmune polyarticular disease. Despite being commonly affected in RA, the ankle and foot do not receive much attention, particularly in early disease. The precise diagnosis of their involvement and its impact on health is a clinical challenge that requires accurate assessment.
To determine the role of ultrasound in evaluation of ankle and foot pathologies and assess its impact on functional activity in newly diagnosed RA patients.
The study was conducted on 152 RA patients and 52 healthy controls. Patients were subjected to history taking, clinical examination, and ultrasound scan. Impact on health was measured by health assessment questionnaire, as well as foot function index.
In a cohort of patients with early RA with median duration of 1 month, tibialis posterior (TP) tenosynovitis (45.4%) was the most common pathology, followed by tibiotalar (TTJ) synovitis (39.8%), and peroneal tenosynovitis (39.1%). In terms of disease duration, TTJ (P = .001) foot pathologies were less common in early RA and tended to worsen over time, whereas TP (P = .048) and peroneal tenosynovitis (P = .011) were more common in early RA. In multivariate analysis TTJ, subtalar synovitis, forefoot pathologies, TP tenosynovitis, and Achilles enthesitis were found to be significant predictors of functional disability. The most important predictors of ankle pain were TTJ synovitis, TP tenosynovitis, peroneal tenosynovitis, and plantar fasciitis.
Ankle and foot involvement is a common issue of early RA, and it has a significant impact on quality of life. Ultrasound is a reliable tool for evaluating various abnormalities in this complex area, allowing for better management.
类风湿关节炎（RA）是一种系统性自身免疫性多关节疾病。尽管踝关节和足部在 RA 中经常受到影响，但在疾病早期，它们并没有受到太多关注。准确诊断其受累情况及其对健康的影响是一个临床挑战，需要进行准确评估。
确定超声在评估踝关节和足部病变中的作用，并评估其对新诊断 RA 患者功能活动的影响。
该研究共纳入 152 例 RA 患者和 52 名健康对照者。对患者进行病史采集、临床检查和超声检查。采用健康评估问卷（HAQ）和足部功能指数（FFI）评估对健康的影响。
在中位病程为 1 个月的早期 RA 患者队列中，最常见的病理改变是比目鱼肌肌腱炎（45.4%），其次是胫距关节（TTJ）滑膜炎（39.8%）和腓肠肌腱炎（39.1%）。就病程而言，TTJ（P =.001）足部病变在早期 RA 中较少见，且随时间推移有恶化趋势，而比目鱼肌肌腱炎（P =.048）和腓肠肌腱炎（P =.011）在早期 RA 中更为常见。多变量分析发现，TTJ、跗骨关节炎、前足病变、比目鱼肌肌腱炎和跟腱附着点炎是功能障碍的显著预测因素。踝关节疼痛的最重要预测因素是 TTJ 滑膜炎、比目鱼肌肌腱炎、腓肠肌腱炎和足底筋膜炎。
踝关节和足部受累是早期 RA 的常见问题，对生活质量有重大影响。超声是评估这一复杂区域各种异常的可靠工具，有助于更好地管理。
