Clinical and ultrasound ankle involvement in rheumatoid arthritis in remission

Abstract

Objective. We aimed to evaluate the prevalence and differences of clinical and ultrasound involvement of ankles in rheumatoid arthritis (RA) patients in remission. Methods. RA patients were recruited in 2018 in the random order of presentation from the out-patient clinic. In the day of enrolment, all patients underwent clinical examination (by a senior rheumatologist, blind to other evaluations), inflammatory markers (e.g. C-reactive protein – CRP) and ankle ultrasound (performed and interpreted by a single rheumatologist with more than 7 years of experience). Results. The sample included 59 patients in DAS28CRP remission, 27 in SDAI remission and 20 in Boolean remission. Among these 3 categories of remission, overall clinical ankle involvement presented similar prevalence (revolving around 30%). On average, 77% of patients presented overall ultrasound ankle involvement among the 3 categories of remission, with similar frequencies of ankle joint synovial hypertrophy (SH; 33%), power Doppler (PD) positive joint SH (15%), ankle joint effusion (60%), ankle tenosynovitis (27%) and PD positive ankle tenosynovitis (15%). In the subgroup of RA patients in DAS28CRP remission, compared to patients without clinical or ultrasound ankle involvement, those with at least one involved ankle had a significantly higher median CRP (0.34 mg/dl versus 0.19 mg/dl, p = 0.042). Conclusion. Among RA patients in remission, regardless of its definition, clinical and ultrasound involvement of ankles is frequent. Clinical and ultrasound screening of ankles in RA patients in remission seems an appropriate strategy.