scholarly journals AB0259 THE RELATIONSHIP BETWEEN MICROVASCULAR DAMAGE AND DISEASE ACTIVITY IN PATIENT WITH RHEUMATOID ARTHRITIS – ASSESSMENT BY VIDEOCAPILAROSCOPY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1428.1-1429
Author(s):  
M. Parvu ◽  
A. Cozos ◽  
A. I. Biro ◽  
H. V. Popoviciu
Keyword(s):  
Rheumatoid Arthritis ◽  
Contact Lenses ◽  
Joint Damage ◽  
Clinical Rheumatology ◽  
Rheumatoid Disease ◽  
Microvascular Damage ◽  
Avascular Area ◽  
Skin Changes ◽  
The Mean ◽  
The Relationship

Background:Rheumatoid arthritis (RA) is an autoimmune disease characterized by erosive synovitis (causing severe joint damage) and systemic damage. Rheumatoid vasculitis (RV) is an extra-articular manifestation of rare but serious rheumatoid disease that involves the damage of small and medium sized vessels.Objectives:The purpose of the study was to evaluate the incidence of damages occurred on cutaneous level in patients diagnosed with RA and to detect capillaroscopic microangiopathy changes in the activity of rheumatoid disease.Methods:101 patients were included in the study, all were diagnosed with RA according to the ACR/EULAR 2010 criteria. RV diagnosis was based on the clinical examination. The capillaroscopic evaluation was performed with a 3.0 VideoCap device at a 200x magnification (200x magnification contact lenses). Capillaroscopic examination was performed on fingers II-V of both hands, being considered pathological if the capillaroscopic changes are present in at least two fingers. The activity of disease was calculated using DAS 28 ESR score.Results:18% of examined patients was male and 82% female, with the mean age of 56,2years±10.16SD, and the mean duration of the disease in years of illness was 8.65±5.31SD. 3 patients had periungual vasculitis with cutaneous ulceration and gangrene, 12 patients had palpable purpura. 29% of the patients had vasospastic skin changes. The activity score of RA was associated with the capillaroscopic changes in peripheral microangiopathy p-0.037. Capillaries images were heterogenous in aspects and distribution, tortuous capillaries, microhemorrhages, giant/dilated capillaries, avascular areas were observed.Conclusion:Vascular microangiopathy evidenced by capillaroscopic examination is present in patients with cutaneous vasculitis having a medium, severe activity of rheumatoid diseases.References:[1]Cutolo M, Paolino S, Smith V. Nailfold capillaroscopy in rheumatology: ready for daily use but care in terminology. Clinical Rheumatology 2019; 38:2293-2297http://doi.org/10/s10067-019-04716-w[2]Lambova N, Müller-Ladner U. Capillaroscopic pattern in inflammatory arthritis. Microvascular Research 2012; 83:318-322Dilated, giant capillaries, microhemorrhage bleedings, avascular areaReduced blood flow (observed in dynamics)Disclosure of Interests:Mirela Parvu Speakers bureau: Not for this subject, theme, Anca Cozos Speakers bureau: Not for this subject, theme, Anna-Iuliana Biro Speakers bureau: Not for this subject, theme, Horatiu Valeriu Popoviciu Speakers bureau: Not for this subject, theme

scholarly journals AB0101 THE IMPACT OF TIME SPAN TO ACHIEVE BOOLEAN REMISSION FOR MAINTAINING DISEASE ACTIVITY AFTER ACQUISITION IN RHEUMATOID ARTHRITIS PATIENT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1079.1-1079
Author(s):  
I. Yoshii
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Duration ◽  
Remission Rate ◽  
Mean Value ◽  
Time Span ◽  
Mean Values ◽  
The Mean ◽  
The Relationship

Background:Boolean remission criteria is one most popular and stringent criteria in treating patient with rheumatoid arthritis (RA), because it may guarantees a stable clinical course after attaining remission.Objectives:Impact of time span from initiation to achieving Boolean remission on maintaining disease activity, daily activities, and quality of life after attaining Boolean remission was investigated from daily clinical practice data.Methods:685 patients with RA since August 2010 under the T2T strategy were treated. They were monitored for their TJC, SJC, PGA, EGA, CRP, and disease activity indices such as CDAI, SDAI, DAS28, and Boolean criteria at every visit. HAQ-DI score, pain score using visual analog scale (PS-VAS), and EQ-5D were also monitored, and the quality of life score (QOLS) calculated from EQ-5D was determined at every visit from the time of diagnosis (baseline).Of 685 patients, 465 patients had achieved Boolean remission >1 times, and were consecutively followed up for >3 years. These patients were enrolled in the study. Time span from the first visit to first Boolean remission was calculated. The relationship between the time span and each of background parameters, and the relationship between the time span and each of the mean values of the SDAI score, HAQ score, PS-VAS, SHS, and QOLS at the first Boolean remission and thereafter was evaluated statistically.Patients were subsequently divided into the G ≤ 6 and G > 6 groups based on the achievement of first Boolean remission within two groups: time span G ≤ 6 months and G > 6 months. The two groups were compared with regard to the SDAI score, HAQ score, PS-VAS, SHS, and QOLS at first visit and at the time of first Boolean remission, and the mean values of these parameters after remission were evaluated statistically. Moreover, changes of these parameters and the mean Boolean remission rate after the first remission, and SDAI remission rate at the first Boolean remission to thereafter were compared between the two groups statistically.Results:Out of 465 patients, females comprised 343 (73.7%), and the mean age was 67.8 years (range, from 21–95 years). The mean disease duration at first visit was 6.1 years (range, from 1 months–45 years). The mean follow up length was 88.1 months (range: 36–122 months; median: 85 months) and mean time span from the first visit to the first Boolean remission was 8.1 months. The mean SDAI score, HAQ score, PS-VAS, and the QOLS at first visit were 13.3, 0.467, 33.2, and 0.834, respectively. Among the study parameters, PS-VAS and QOLS were significantly correlated with the time span. For parameters at the first Boolean remission, HAQ-DI score, PS-VAS, and QOLS demonstrated significant correlation with the time span, whereas SDAI, HAQ-DI score, PS-VAS, SHS, and QOLS after the Boolean remission demonstrated significant correlation with the time span.The comparison between the G ≤ 6 and the G > 6 groups revealed that the disease duration, HAQ score, and PS-VAS at baseline in the G > 6 were significantly higher than that in the G ≤ 6 group, and QOLS in the G ≤ 6 group was significantly higher than that in the G > 6 group at baseline. Similarly, the HAQ score and PS-VAS at the first Boolean remission in the G > 6 group were significantly higher than that in the G ≤ 6 group, whereas QOLS in the G ≤ 6 group demonstrated no significant difference compared with that in the G > 6 group.The mean value of the SDAI score after the first Boolean remission in the G > 6 group was significantly higher than that in the G ≤ 6 group. Similarly, the SDAI score, HAQ score, and PS-VAS after the first Boolean remission in the G > 6 group were also significantly higher than those in the G ≤ 6 group, and the mean value of the QOLS in the G ≤ 6 group were significantly higher than that in the G > 6 group. The Boolean remission rate and SDAI remission rate after the first Boolean remission were significantly higher in the G ≤ 6 group than those in the G > 6 group.Conclusion:Attaining Boolean remission ≤ 6 months for RA has significant benefit for more stable disease control, that leads good maintenance of ADL.Disclosure of Interests:None declared

SAT0119 The relationship between inflammation and joint damage in rheumatoid arthritis is dependent on anti-CCP status

2013 ◽  
Vol 71 (Suppl 3) ◽  
pp. 510.2-511
Author(s):  
Y. De Punder ◽  
J. Hendrikx ◽  
E. Valls Pascual ◽  
P. van Riel ◽  
J. Fransen
Keyword(s):  
Rheumatoid Arthritis ◽  
Joint Damage ◽  
The Relationship

scholarly journals The Relationship Between Synovial Pathobiology and Magnetic Resonance Imaging Abnormalities in Rheumatoid Arthritis: A Systematic Review

2017 ◽  
Vol 44 (9) ◽  
pp. 1311-1324 ◽  
Author(s):  
Frances Humby ◽  
Arti Mahto ◽  
Muaaze Ahmed ◽  
Andrew Barr ◽  
Stephen Kelly ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Magnetic Resonance Imaging ◽  
Systematic Review ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Bone Erosion ◽  
Critical Role ◽  
Joint Damage ◽  
Resonance Imaging ◽  
The Relationship

Objective.Magnetic resonance imaging (MRI) has been increasingly recognized as a critical tool for the assessment of patients with rheumatoid arthritis (RA) and is able to reliably identify synovitis, bone marrow edema, bone erosion, and joint space narrowing (JSN)/cartilage loss. Understanding the exact relationship between each MRI feature and local synovial pathobiology is critical to dissect disease pathogenesis as well as develop future predictive models.Methods.A systematic review was performed of the current published literature examining the relationship between MRI abnormalities and synovial pathobiology in patients with RA.Results.Eighteen studies were identified; most focused on validation of MRI as a tool to detect and quantify synovitis, with a significant relationship demonstrated. Additionally, from the limited data available, a critical role seems likely for synovial pathways, at least in driving joint damage. However, there was a lack of data examining the relationship between synovial pathobiology and bone marrow abnormalities and JSN.Conclusion.Although understanding the interrelationship of these disease biomarkers offers the potential to enhance the predictive validity of modern imaging with concomitant synovial pathobiological analysis, further studies integrating MRI with synovial tissue analysis in well-controlled cohorts at distinct disease stages before and after therapeutic intervention are required to achieve this.

scholarly journals Reverse shoulder joint replacement in rheumatoid arthritis: medium-term results in 37 patients

2018 ◽  
Vol 12 (3) ◽  
pp. 89-93
Author(s):  
M. A. Makarov ◽  
A. A. Roskidailo ◽  
M. V. Panteleev
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Functional Status ◽  
Upper Limb ◽  
Joint Replacement ◽  
Shoulder Joint ◽  
Joint Damage ◽  
Dash Score ◽  
The Mean

Objective:to assess functional results and quality of life in patients with rheumatoid arthritis (RA) after reverse shoulder joint replacement.Patients and methods.Examinations were made in 37 patients with RA involving the shoulder joint, who underwent shoulder joint replacement using a reverse DeltaX-tend DePuy prosthesis in 2006–2017. The investigators studied the volume of movements, the level of pain using the visual analogue scale, the function of the shoulder joint using the American Shoulder and Elbow Surgeons (ASES) Shoulder Score and the upper limb as a whole by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, a patient's functional status by the Health Assessment Questionnaire (HAQ), quality of life (QL) by EQ-5D (Euro Quolish instrument) and analyzed shoulder X-ray films before and in the late periods after surgery.Results.The volume of shoulder joint movements was found to increase. At 28.7 months postsurgery, the mean volume of flexion, abduction, and external rotation was 107.4Ѓ}15.2, 128.3Ѓ}8.5, and 46.4Ѓ}5.5°; respectively (p≤0.05). The patients experienced no pain in the late periods following surgery. Prior to surgery and at control examination, the mean ASES scores were 25.0Ѓ}4.7 and 79.4Ѓ}6.4, respectively (p≤0.05). Before surgery, the mean DASH score was 63.8Ѓ}4.2; in the late periods it decreased to 18.2Ѓ}8.6 (p ≤ 0.05). The mean preoperative HAQ score was 2.81; following surgery, it also decreased to 1.39 (p≤0.05). The postoperative EQ-5D QOL index score increased from 0.41 to 0.72. The rate of complications reached 10.8%.Conclusion.Reverse endoprosthetic replacement for end-stage shoulder joint damage (Larsen 4–5) with rotator cuff defect makes it possible to increase the volume of movements, to reduce pain, and to improve upper limb function, functional status, and quality of life in patients with RA.

scholarly journals Linkage and Association Studies of Joint Morbidity from Rheumatoid Arthritis

2009 ◽  
Vol 37 (2) ◽  
pp. 291-295 ◽  
Author(s):  
JIN-YOUNG MIN ◽  
KYOUNG-BOK MIN ◽  
JOOHON SUNG ◽  
SUNG-IL CHO
Keyword(s):  
Rheumatoid Arthritis ◽  
Association Studies ◽  
Clinical Signs ◽  
Joint Damage ◽  
Genetic Variations ◽  
Nucleotide Polymorphisms ◽  
Sibling Pairs ◽  
Rf Values ◽  
Family Based ◽  
The Relationship

Objective. To investigate the relationship between genetic variations of rheumatoid arthritis (RA) susceptibility in terms of joint morbidity.Methods. We used data from Genetic Analysis Workshop 15. The Illumina linkage panel IV included 5858 single-nucleotide polymorphisms (SNP), with 5744 SNP passing quality control filters. The phenotypic variables analyzed were the level of rheumatoid factor (RF) and score on the Joint Alignment and Motion (JAM) scale. We modified the scale, dividing by RF values relevant to disease severity. Linkage analysis for affected sibling pairs was done using the MERLIN program, and family-based association tests were carried out using PLINK and FBAT software.Results. We found a high peak (LOD = 3.29; NPL Z = 4.07) near the HLA-DRB1 region on chromosome 6. The linkage at 6p24 at rs1410766 [LOD = 2.66; nonparametric linkage (NPL) Z = 3.23] was statistically significant. Two other regions also showed possible linkage peaks: chromosome 7q30 at rs322812 (LOD = 2.47; NPL Z = 3.39) and chromosome 15p34 at rs347117 (LOD = 1.95; NPL Z = 2.80). For the family-based association study, 7 SNP related to clinical RA severity were detected.Conclusion. Genetic variations may lead to an enhanced risk of joint damage and increased levels of RF. Further studies are needed to elucidate the roles of other genes involved in RA and to explore whether the clinical signs of RA are associated with particular genetic variations.

The relationship between joint damage and functional disability in rheumatoid arthritis: a systematic review

2011 ◽  
Vol 71 (6) ◽  
pp. 836-844 ◽  
Author(s):  
Claire Bombardier ◽  
Marco Barbieri ◽  
Anju Parthan ◽  
Debra J Zack ◽  
Valery Walker ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Functional Disability ◽  
Joint Damage ◽  
The Relationship

scholarly journals AB0864-HPR INFLUENCE OF THE TYPE OF PAIN SYNDROME ON THE SEVERITY OF ANXIETY-DEPRESSIVE DISORDERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1455.2-1456
Author(s):  
E. Egorova ◽  
N. Nikitina ◽  
A. Rebrov
Keyword(s):  
Rheumatoid Arthritis ◽  
Severe Pain ◽  
Depressive Disorders ◽  
Functional Limitations ◽  
Joint Damage ◽  
Statistical Processing ◽  
Pain Syndrome ◽  
Anxiety And Depression ◽  
Moderate Pain ◽  
The Relationship

Background:Rheumatoid arthritis (RA) is a chronic autoimmune disease that leads to joint damage and deformation. Pain syndrome, along with functional limitations, causes the emergence of anxiety-depressive disorders. The patient’s psycho-emotional characteristics affect the patient’s quality of life and the effectiveness of the therapy. The aim: to assess the severity of anxiety and depression in women with rheumatoid arthritis, depending on the type of the pain syndrome.Objectives:The study included 163 women with RA according to the EULAR / ACR 2010 criteria (age 53,9 ± 10,15 years, RA duration - 10 [4; 14] years, DAS28 – 5,03 [4,35; 5,8]).Methods:We used the Hospital Depression and Anxiety Scale (HADS) questionnaire: 0-7 points were assessed as the absence of significant symptoms of anxiety and depression, 8-10 points - subclinically expressed anxiety and depression, more than 11 points - clinically expressed anxiety and depression. The severity of pain was determined by the VAS: no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), severe pain (75-100 mm). Assessment of the type of pain (identification of the neuropathic component of pain) was carried out using the DN4 questionnaire: a sum of 4 or more points indicated the presence of a neuropathic component of pain (NCP). Statistical processing was performed using the STATISTICA 10,0 program.Results:The frequency of occurrence of anxiety-depressive disorders in RA patients was determined: clinically pronounced anxiety was detected in 35 (21,4%) patients, depression - in 34 (20,9%); subclinically expressed anxiety - in 42 (25,8%), depression - in 44 (27%) patients; absence of reliably pronounced symptoms of anxiety - in 86 (52,8%) patients, depression - in 85 (52,1%) patients.Severe pain according to VAS was noted in 57 (35%) patients, moderate pain - in 75 (46%), in 31 (19%) patients the pain syndrome was mild. In 81 (49,7%) patients a neuropathic component of pain was revealed.The relationship was established between the presence of NCP and the severity of anxiety (r = 0,27, p < 0,05), depression (r = 0,31, p <0,05). The relationship was revealed between the presence of NCP and the severity of pain according to the VAS (r = 0.32, p <0.05).To explain the relationship between the presence of NCP and anxiety-depressive disorders, the patients were divided into two groups depending on the presence of NCP, comparable in age, the main clinical characteristics of RA, and basic therapy. The level of anxiety in women with NCP (9,5 [7; 13]) was significantly higher than in patients without NCP (6.1 [4; 9]) (p = 0.01). The severity of depression in women with NCP was 8,55 [6; 11], in patients without NCP – 5,15 [3; 6] (p = 0.005).Conclusion:Thus, every fifth patient with RA had clinically significance anxiety and depression, subclinical anxiety and depression were found in 26% of RA patients. Most of the patients (81%) had moderate or severe pain, half of the patients had signs of neuropathic pain. The relationship between the severity of anxiety and depression with the intensity of pain and the presence of a neuropathic component was revealed.Disclosure of Interests:None declared

scholarly journals AB0134 RELATIONSHIP BETWEEN INFLAMMATORY RATIOS AND RADIOGRAPHIC JOINT DAMAGE IN RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1095.2-1095
Author(s):  
F. Maatoug ◽  
M. Slouma ◽  
R. Dhahri ◽  
O. Beskri ◽  
I. Gharsallah ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Structural Damage ◽  
Joint Space Narrowing ◽  
Joint Damage ◽  
Joint Space ◽  
Albumin Ratio ◽  
Sharp Score ◽  
The Mean ◽  
Modified Sharp Score ◽  
Joint Erosion

Background:The tight control strategy is recommended in rheumatoid arthritis to tailor treatment for patients. This strategy requires regular monitoring of both disease activity and structural damage. However, radiographic assessement cannot be performed frequently and the modified Sharp score is rarely evaluated in current practice. Besides, no biomarker was able to mirror structural damage (1).Objectives:Our study aimed to assess the relationship between the modified Sharp score and the inflammatory ratios (platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), fibrinogen to albumin ratio (FAR) and CRP to albumin ratio (CAR)).Methods:We performed a cross-sectional study including 53 patients with rheumatoid arthritis (RA). A cell blood count, fibrinogen and an albumin blood test were measured for each patient. Inflammatory ratios were also measured (PLR, NLR, LMR, FAR, and CAR). Modified Sharp score and its components (erosion score and joint space narrowing score) were evaluated using the radiograph of hand and foot.Patients with infectious or hematological diseases were excluded from the study.Statistical analysis was performed using SPSS (Statistical Package for Social Sciences).Results:Of the 53 patients, 39 were female (Sex Ratio: 2.8). The mean age was 53.9 ± 12.7 years. The mean disease duration was 10.1 ± 8.2 years.The average age of the onset of the disease was 43.8±13.5 years.The mean DAS 28-ESR score was 4.64 ± 1.23. Forty three patients had a score higher than 3.2 (patients with moderate or high disease activity).The mean values of PLR, NLR, LMR, FAR and CAR were 161.62 ± 86.59, 2.84 ± 2.39, 4.99 ± 3.23, 0.12 ± 0.06 and 1.15 ± 1.38.The mean scores of joint erosion and joint space narrowing were respectively 12.76 ± 15.05 and 33.57 ± 25.80. The mean modified Sharp score was 46.33 ± 37.74.There was a positive correlation between modified Sharp score and following ratios: PLR (r: 0.501; p <10-3), NLR (r: 0.302; p:0.031), FAR (r: 0.300; p:0.030), CAR (r:0.286; p:0.042).Moreover, a positive correlation between joint space narrowing score and these ratios was identified: PLR (r: 0.558; p <10-3), NLR (r: 0.428; p:0.002), FAR (r: 0.371; p:0.007), CAR (r:0.387; p:0.005).Joint erosion score correlated with PLR (r: 0.299; p:0.033).No correlation was found between LMR and radiographic score.Conclusion:Our study showed that the modified Sharp score correlated with PLR, NLR, FAR and CAR in patients with RA. This finding suggests that these ratios could be used as inexpensive and reliable markers to reflect radiographic joint damage.Longitudinal studies are necessary to confirm our results.References:[1]Syversen SW, Landewe R, Van Der Heijde D, Bathon JM, Boers M, Bykerk VP, et al. Testing of the OMERACT 8 draft validation criteria for a soluble biomarker reflecting structural damage in rheumatoid arthritis: a systematic literature search on 5 candidate biomarkers. J Rheumatol. 2009;36(8):1769-84.Disclosure of Interests:None declared

The Temporal Relationship of Raynaud’s Phenomenon and Features of Connective Tissue Disease in Rheumatoid Arthritis

2008 ◽  
Vol 35 (12) ◽  
pp. 2329-2333 ◽  
Author(s):  
JANET E. POPE ◽  
JAMAL AL-BISHRI ◽  
HAFSAH AL-AZEM ◽  
JANINE M. OUIMET
Keyword(s):  
Rheumatoid Arthritis ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Disease Duration ◽  
Late Onset ◽  
Raynaud’S Phenomenon ◽  
Joint Damage ◽  
Raynaud's Phenomenon ◽  
Rf Values ◽  
The Mean

ObjectiveIn a prospective cohort study we examined the relationship between Raynaud’s phenomenon (RP) onset and other connective tissue disease (CTD) characteristics in rheumatoid arthritis (RA) to determine if RP is predictive of RA severity and associated with other CTD signs, and if late onset RP in RA has an effect on prognosis compared to other patients with RA.MethodsUsing a standardized assessment, data were collected on 328 subjects with RA [mean age 60.3 ± 0.7; 77% women; 76% erosions, 75% positive rheumatoid factor (RF)] seen at one London, Ontario, rheumatology clinic. The data included RA disease duration; presence and duration of RP; presence of nodules, joint damage, telangiectasia, and sclerodactyly; and RF status (+/−), RF value, antinuclear antibodies, and E-nuclear antibodies.ResultsThe mean RA disease duration was 12 ± 0.6 years. Seventy-one (22%) had RP and the mean RP duration was 9.2 ± 1.5 years. Patients presented with RP a mean of 3.8 ± 1.4 years after the diagnosis of RA. RP status was positively associated with the presence of sclerodactyly (p < 0.001), but not nodules or erosions. Higher RF values were associated with longer RA disease duration (p < 0.002) and longer RP duration (p < 0.01).ConclusionIdiopathic RP may have a different clinical effect on RA than secondary RP; the latter is correlated with more severe RA. Sclerodactyly is associated with erosive arthritis and RP in RA. Higher RF values were indicative of increased RA and RP duration.

scholarly journals POS0538 RELATIONSHIP BETWEEN HINDFOOT DEFORMITIES AND ULTRASOUND TENOSYNOVITIS IN RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 503.1-503
Author(s):  
K. Maatallah ◽  
H. Boussaa ◽  
H. Riahi ◽  
H. Ferjani ◽  
M. Habechi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Soft Tissues ◽  
Power Doppler ◽  
Tibialis Posterior ◽  
Foot Deformities ◽  
P Value ◽  
Flexor Hallucis Longus ◽  
Hindfoot Deformities ◽  
The Mean ◽  
The Relationship

Background:Rheumatoid arthritis (RA) is an inflammatory disease that frequently affects the joints and soft tissues of the feet. Tibialis posterior tenosynovitis has a reported prevalence between 13 and 64% in RA. The condition is associated with a progressive flat foot deformity and significant gait disability. However, few studies have investigated the relationship between foot deformities and the involvement of tendons. Recently, ultrasonography (US) has been reported as the gold standard for the investigation of tendons.Objectives:This study aimed to assess the relationship between hindfoot deformities and US tenosynovitis in RA.Methods:We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. For each patient, a podoscope examination of both feet was performed by a rheumatologist. A radiologist experienced in musculoskeletal imaging performed a US examination using a Philips HD11 device with a high-frequency linear transducer. The assessed lesions were synovitis of the tibiotalar, talonavicular, and subtalar joints, and tenosynovitis of tibialis anterior (TA), extensor hallucis longus (EHL), extensor digitorum longus (EDL), tibialis posterior (TP), flexor digitorum longus (FDL), flexor hallucis longus (FHL), fibularis brevis (FB) and fibularis longus (FL) tendons. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler/grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.Results:Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in respectively 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].Podoscope examination revealed pes planus valgus (PPV) in 55.6% of cases and pes cavus varus (PCV) in 18.5% of cases. US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. In the anterior compartment, tenosynovitis of TA was noted in 5.6% of cases, of EHL in 1.9% of cases, and EDL in 9.3% of cases. In the medial compartment, tenosynovitis of TP was found in 22.2% of cases, of FDL in 5.6% of cases, and FHL in 0% of cases. In the lateral compartment, tenosynovitis of FB and FL was found in 25% and 11.1% of cases respectively.An association between PPV and synovitis of the tibiotalar joint (p<0.001) and the subtalar joint (p=0.007) was found. An association was also noted with FL tenosynovitis (p=0.045) but not with the other assessed tendons.No association was noted between PCV and synovitis or tenosynovitis of the assessed structures.Conclusion:PPV was frequent among RA patients. This condition was associated with tibiotalar and subtalar synovitis and FL tenosynovitis. It is important to detect and correct foot deformities in order to ensure optimal control of the disease.Disclosure of Interests:None declared

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