Ultrasound of the Foot and Ankle in Peripheral Spondyloarthritis

Abstract

Seronegative spondyloarthritis (SpA) is an umbrella term that includes ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis, and arthritis related to inflammatory bowel disease. Apart from AS, these other conditions predominantly affect the appendicular skeleton. Both the foot and ankle are frequently involved peripheral joints. According to the latest Assessment of Spondyloarthritis International Society criteria, imaging is a key way to diagnose peripheral seronegative SpA. Common imaging features are enthesitis, synovitis, tenosynovitis, erosive and bone-proliferative changes in the affected joints, and effusion.

Although magnetic resonance imaging is the gold standard technique, ultrasound (US) is a cost-effective imaging method that can readily detect the features just described. Additionally, it can semi-quantify inflammatory changes, helping in treatment and dose modifications. Imaging-guided procedures, such as biopsies and steroid injections, are routinely performed using US. Furthermore, US can easily be deployed at outpatient rheumatology clinics, making it an ideal point-of-care investigation.

Keywords

peripheral spondyloarthritis - foot and ankle - ultrasound - enthesitis - psoriatic arthritis

Publikationsverlauf

Artikel online veröffentlicht:
19. November 2024

• References

• 1 Wright V. Seronegative polyarthritis: a unified concept. Arthritis Rheum 1978; 21 (06) 619-633
• 2 Wright V, Moll JMH. Seronegative Polyarthritis. Amsterdam, Netherlands: North-Holland; 1976
• 3 Rudwaleit M, van der Heijde D, Landewé R. et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70 (01) 25-31
• 4 Dougados M, van der Linden S, Juhlin R. et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991; 34 (10) 1218-1227
• 5 Benjamin M, McGonagle D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat 2001; 199 (Pt 5): 503-526
• 6 McGonagle D, Aydin SZ, Tan AL. The synovio-entheseal complex and its role in tendon and capsular associated inflammation. J Rheumatol Suppl 2012; 89 (Suppl. 89) 11-14
• 7 McGonagle D, Lories RJU, Tan AL, Benjamin M. The concept of a “synovio-entheseal complex” and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum 2007; 56 (08) 2482-2491
• 8 Shaw HM, Santer RM, Watson AHD, Benjamin M. Adipose tissue at entheses: the innervation and cell composition of the retromalleolar fat pad associated with the rat Achilles tendon. J Anat 2007; 211 (04) 436-443
• 9 Theobald P, Bydder G, Dent C, Nokes L, Pugh N, Benjamin M. The functional anatomy of Kager's fat pad in relation to retrocalcaneal problems and other hindfoot disorders. J Anat 2006; 208 (01) 91-97
• 10 Sahli H, Bachali A, Tekaya R. et al. Involvement of foot in patients with spondyloarthritis: prevalence and clinical features. Foot Ankle Surg 2019; 25 (02) 226-230
• 11 Crespo-Rodríguez AM, Sanz Sanz J, Freites D, Rosales Z, Abasolo L, Arrazola J. Role of diagnostic imaging in psoriatic arthritis: how, when, and why. Insights Imaging 2021; 12 (01) 121
• 12 Patience A, Helliwell PS, Siddle HJ. Focussing on the foot in psoriatic arthritis: pathology and management options. Expert Rev Clin Immunol 2018; 14 (01) 21-28
• 13 Galluzzo E, Lischi DM, Taglione E. et al. Sonographic analysis of the ankle in patients with psoriatic arthritis. Scand J Rheumatol 2000; 29 (01) 52-55
• 14 Pass B, Robinson P, Ha A, Levine B, Yablon CM, Rowbotham E. The Achilles tendon: imaging diagnoses and image-guided interventions- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 219 (03) 355-368
• 15 Baraliakos X, Kiltz U, Appel H. et al. Chronic but not inflammatory changes at the Achilles' tendon differentiate patients with peripheral spondyloarthritis from other diagnoses - results from a prospective clinical trial. RMD Open 2017; 3 (02) e000541
• 16 Frey C, Rosenberg Z, Shereff MJ, Kim H. The retrocalcaneal bursa: anatomy and bursography. Foot Ankle 1992; 13 (04) 203-207
• 17 Forien M, Ebstein E, Léger B, Benattar L, Dieudé P, Ottaviani S. Ankle retinacula abnormalities as features of psoriatic arthritis: an ultrasound study. Joint Bone Spine 2024; 91 (01) 105649
• 18 Smith E, Azzopardi C, Thaker S, Botchu R, Gupta H. Power Doppler in musculoskeletal ultrasound: uses, pitfalls and principles to overcome its shortcomings. J Ultrasound 2021; 24 (02) 151-156
• 19 Seskute G, Montvydaite M, Butrimiene I. Power Doppler artifacts in evaluating inflammatory arthritis of small joints: comparison with a superb microvascular imaging technique. J Ultrasound 2022; 25 (03) 765-771
• 20 Kandemirli SG, Cicek F, Erdemli Gursel B, Bilgin C, Kilic SS, Yazici Z. Superb microvascular imaging in assessment of synovitis and tenosynovitis in juvenile idiopathic arthritis. Ultrasound Q 2021; 37 (01) 56-62
• 21 Erdem CZ, Sarikaya S, Erdem LO, Ozdolap S, Gundogdu S. MR imaging features of foot involvement in ankylosing spondylitis. Eur J Radiol 2005; 53 (01) 110-119
• 22 Precerutti M, Bonardi M, Ferrozzi G, Draghi F. Sonographic anatomy of the ankle. J Ultrasound 2013; 17 (02) 79-87
• 23 Gibbon WW, Long G. Ultrasound of the plantar aponeurosis (fascia). Skeletal Radiol 1999; 28 (01) 21-26
• 24 Chen H, Ho HM, Ying M, Fu SN. Association between plantar fascia vascularity and morphology and foot dysfunction in individuals with chronic plantar fasciitis. J Orthop Sports Phys Ther 2013; 43 (10) 727-734
• 25 McMillan AM, Landorf KB, Gregg JM, De Luca J, Cotchett MP, Menz HB. Hyperemia in plantar fasciitis determined by power Doppler ultrasound. J Orthop Sports Phys Ther 2013; 43 (12) 875-880
• 26 Jacobson JA, Girish G, Jiang Y, Resnick D. Radiographic evaluation of arthritis: inflammatory conditions. Radiology 2008; 248 (02) 378-389
• 27 Liew IY, Mak TM, Cui L, Vasoo S, Lim XR. A case of reactive arthritis secondary to coronavirus disease 2019 infection. J Clin Rheumatol 2020; 26 (06) 233
• 28 Nevalainen MT, Pitkänen MM, Saarakkala S. Diagnostic performance of ultrasonography for evaluation of osteoarthritis of ankle joint: comparison with radiography, cone-beam CT, and symptoms. J Ultrasound Med 2022; 41 (05) 1139-1146
• 29 Kok AC, Terra MP, Muller S. et al. Feasibility of ultrasound imaging of osteochondral defects in the ankle: a clinical pilot study. Ultrasound Med Biol 2014; 40 (10) 2530-2536
• 30 Oo WM, Linklater JM, Daniel M. et al. Clinimetrics of ultrasound pathologies in osteoarthritis: systematic literature review and meta-analysis. Osteoarthritis Cartilage 2018; 26 (05) 601-611
• 31 Stolt M, Suhonen R, Leino-Kilpi H. Foot health in patients with rheumatoid arthritis-a scoping review. Rheumatol Int 2017; 37 (09) 1413-1422
• 32 Hernández-Díaz C, Sánchez-Bringas G, Ventura-Ríos L, Robles-San Román M, Filippucci E. Ankle pain in rheumatoid arthritis: comparison of clinical and sonographic findings. Clin Rheumatol 2019; 38 (10) 2891-2895
• 33 Bruyn GAW, Siddle HJ, Hanova P. et al. Ultrasound of subtalar joint synovitis in patients with rheumatoid arthritis: results of an OMERACT reliability exercise using consensual definitions. J Rheumatol 2019; 46 (04) 351-359
• 34 Enache L, Popescu CC, Micu M. et al. Ankle involvement in rheumatoid arthritis—a comparison of inflammatory signs on musculoskeletal ultrasound and magnetic resonance imaging. Med Ultrason 2019; 21 (03) 265-272
• 35 Sudoł-Szopińska I, Żelnio E, Olesińska M. et al. Update on current imaging of systemic lupus erythematous in adults and juveniles. J Clin Med 2022; 11 (17) 5212
• 36 Giraudo C, Fichera G, Ganguly S, Arumugam M, Cecchin D, Rennie WJ. Ankle and foot: focus on inflammatory disease. Semin Musculoskelet Radiol 2023; 27 (03) 327-336
• 37 Frediani B, Falsetti P, Storri L. et al. Evidence for synovitis in active polymyalgia rheumatica: sonographic study in a large series of patients. J Rheumatol 2002; 29 (01) 123-130
• 38 Bechman K, Christidis D, Walsh S, Birring SS, Galloway J. A review of the musculoskeletal manifestations of sarcoidosis. Rheumatology (Oxford) 2018; 57 (05) 777-783
• 39 Weaver JS, Vina ER, Munk PL, Klauser AS, Elifritz JM, Taljanovic MS. Gouty arthropathy: review of clinical manifestations and treatment, with emphasis on imaging. J Clin Med 2021; 11 (01) 166
• 40 Neogi T, Jansen TLTA, Dalbeth N. et al. 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 2015; 67 (10) 2557-2568
• 41 Richette P, Doherty M, Pascual E. et al. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2020; 79 (01) 31-38
• 42 Chowalloor PV, Siew TK, Keen HI. Imaging in gout: a review of the recent developments. Ther Adv Musculoskelet Dis 2014; 6 (04) 131-143
• 43 Choi HK, Al-Arfaj AM, Eftekhari A. et al. Dual energy computed tomography in tophaceous gout. Ann Rheum Dis 2009; 68 (10) 1609-1612
• 44 Dalbeth N, Kalluru R, Aati O, Horne A, Doyle AJ, McQueen FM. Tendon involvement in the feet of patients with gout: a dual-energy CT study. Ann Rheum Dis 2013; 72 (09) 1545-1548
• 45 Zhang W, Doherty M, Bardin T. et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis 2011; 70 (04) 563-570
• 46 Illian C, Kortmann HR, Künstler HO, Poll LW, Schofer M. Tenosynovial giant cell tumors as accidental findings after episodes of distortion of the ankle: two case reports. J Med Case Rep 2009; 3: 9331
• 47 Tritschler P, Baudrez V, Mutijima E. Diffuse pigmented villonodular synovitis of the subtalar joint. J Belg Soc Radiol 2018; 102 (01) 11
• 48 Romero-López JP, Elewaut D, Pacheco-Tena C, Burgos-Vargas R. Inflammatory foot involvement in spondyloarthritis: from tarsitis to ankylosing tarsitis. Front Med (Lausanne) 2021; 8: 730273
• 49 Omar IM, Weaver JS, Altbach MI. et al. Imaging of osteoarthritis from the ankle through the midfoot. Skeletal Radiol 2023; 52 (11) 2239-2257
• 50 Pieruzzi L, Napoli V, Goretti C. et al. Ultrasound in the modern management of the diabetic foot syndrome: a multipurpose versatile toolkit. Int J Low Extrem Wounds 2020; 19 (04) 315-333
• 51 Gandjbakhch F, Terslev L, Joshua F, Wakefield RJ, Naredo E, D'Agostino MA. OMERACT Ultrasound Task Force. Ultrasound in the evaluation of enthesitis: status and perspectives. Arthritis Res Ther 2011; 13 (06) R188
• 52 Bakewell CJ, Olivieri I, Aydin SZ. et al; OMERACT Ultrasound Task Force. Ultrasound and magnetic resonance imaging in the evaluation of psoriatic dactylitis: status and perspectives. J Rheumatol 2013; 40 (12) 1951-1957
• 53 Sudoł-Szopińska I, Jurik AG, Eshed I. et al. Recommendations of the ESSR Arthritis Subcommittee for the use of magnetic resonance imaging in musculoskeletal rheumatic diseases. Semin Musculoskelet Radiol 2015; 19 (04) 396-411
• 54 Poggenborg RP, Terslev L, Pedersen SJ, Østergaard M. Recent advances in imaging in psoriatic arthritis. Ther Adv Musculoskelet Dis 2011; 3 (01) 43-53
• 55 Salet E, Legghe B, Barouk P. et al. Imaging of the post-operative hallux valgus: what do radiologists need to know?. Skeletal Radiol 2023; 52 (09) 1629-1637
• 56 van Dijk BT, Wouters F, van Mulligen E, Reijnierse M, van der Helm-van Mil AHM. During development of rheumatoid arthritis, intermetatarsal bursitis may occur before clinical joint swelling: a large imaging study in patients with clinically suspect arthralgia. Rheumatology (Oxford) 2022; 61 (07) 2805-2814
• 57 Cohen SL, Miller TT, Ellis SJ, Roberts MM, DiCarlo EF. Sonography of Morton neuromas: what are we really looking at?. J Ultrasound Med 2016; 35 (10) 2191-2195
• 58 Deplano L, Piga M, Porcu M. et al. Whole-body MRI in rheumatology: major advances and future perspectives. Diagnostics (Basel) 2021; 11 (10) 1770
• 59 Guo Z, Li B, Zhang Y. et al. Peripheral enthesitis assessed by whole-body MRI in axial spondyloarthritis: distribution and diagnostic value. Front Immunol 2022; 13: 976800