Azzam Adel Ibrahim
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
J Med Ultrasound. 2024 Apr 22;33(1):15-22. doi: 10.4103/jmu.jmu_111_23. eCollection 2025 Jan-Mar.
Rheumatoid arthritis (RA) is a form of inflammatory disease whose clinical pattern is largely dependent on the presence of both anti-citrullinated protein antibodies and rheumatoid factor (RF). Although this is still debatable, seronegative RA seems to be a somewhat less serious condition. The present study aimed to evaluate ankle joint ultrasound in relation to RF status and disease activity in RA patients.
A cross-sectional study involving RA patients from a single center was conducted. Laboratory test evaluations and clinical activity assessments were carried out. The ankle joint was examined using musculoskeletal ultrasound (US).
The study included 100 patients with established RA in total. Eighty-two patients tested positive for RF with a mean age of 42.3, whereas only 18 tested negative with a mean age of 39.6. Patients who tested positive for RF had a longer duration of illness (9.39 ± 5.39 vs. 4.56 ± 3.24). There were no differences in clinical activity scores between the seropositive and seronegative groups. The pathological US findings of any ankle joint showed no differences between the seropositive and seronegative groups. Patients with US findings of tibialis posterior tenosynovitis in the left ankle and synovitis and erosion in the right ankle, particularly in the tibiotalar and talonavicular joints, had significantly high Disease Activity Score 28-Erythrocyte sedimentation rate-scores. The increased disease activity was accompanied by significant erosions on both ankles.
In terms of disease activity, there is no clinically significant difference between seropositive and seronegative RA patients. Sonographic ankle joint abnormalities do not appear to be associated with the patients' RF status. High RA disease activity, on the other hand, is associated with synovitis and erosions, particularly in the talonavicular and tibiotalar joints, as well as tibialis posterior tenosynovitis.
类风湿关节炎（RA）是一种炎症性疾病，其临床症状很大程度上取决于抗瓜氨酸化蛋白抗体和类风湿因子（RF）的存在。尽管这一点仍有争议，但血清阴性RA似乎病情稍轻。本研究旨在评估RA患者踝关节超声与RF状态及疾病活动度的关系。
进行了一项涉及来自单一中心的RA患者的横断面研究。进行了实验室检查评估和临床活动评估。使用肌肉骨骼超声（US）检查踝关节。
该研究共纳入100例确诊为RA的患者。82例RF检测呈阳性，平均年龄42.3岁，而只有18例检测呈阴性，平均年龄39.6岁。RF检测呈阳性的患者病程更长（9.39±5.39对4.56±3.24）。血清阳性组和血清阴性组的临床活动评分没有差异。血清阳性组和血清阴性组之间任何踝关节的超声病理表现均无差异。左踝胫后肌腱滑膜炎以及右踝滑膜炎和糜烂，特别是在胫距关节和距舟关节，超声检查有这些表现的患者疾病活动评分28-红细胞沉降率评分显著较高。疾病活动度增加伴随着双踝明显的糜烂。
在疾病活动度方面，血清阳性和血清阴性RA患者之间没有临床显著差异。踝关节超声异常似乎与患者的RF状态无关。另一方面，高RA疾病活动度与滑膜炎和糜烂有关，特别是在距舟关节和胫距关节，以及胫后肌腱滑膜炎。
