Abstract
This study aimed to evaluate neuropathic foot pain in patients with rheumatoid arthritis (RA) using electrophysiological studies and musculoskeletal ultrasound (MSUS) to address the association between these findings and disease activity. Evaluation of the usefulness of this combination was undertaken. The present study was designed as a cross-sectional study. A total of 50 RA patients underwent a complete history-taking and rheumatologic examination. According to the cut-off point of Disease Activity Score in 28 joints, patients were divided into two equal groups (25 patients each): active and inactive. In total, 25 healthy individuals were included as controls. Routine tibial and peroneal nerve conduction studies, as well as electromyography of tibialis anterior and abductor hallucis muscles, were carried out. MSUS assessment of the ankle joint and extra-articular portion of the foot complex was also performed. Electrophysiological findings of foot neuropathy were observed in 78% of the patients, irrespective of the disease activity level. In total, 48% of the patients had mononeuropathies of a demyelinating pattern (entrapment neuropathies), whereas the other 30% had symmetrical polyneuropathy with axonal degeneration. Combined distal tibial and peroneal nerve entrapments were reported in 16% of the patients. A positive power Doppler signal and joint erosions showed a highly statistical significant prevalence among the active group in comparison with patients in remission (P ≤ 0.001). Peripheral nerve affection is common in the rheumatoid foot, irrespective of the disease activity status. The most common neuropathies were posterior tarsal tunnel syndrome, peroneal nerve entrapment at the fibular neck, and pure sensory axonal neuropathy. A positive power Doppler signal and bone erosions of the ankle joint, detected by MSUS, were associated with RA disease activity. Electrophysiology was superior to MSUS for the diagnosis of posterior tarsal tunnel syndrome.
Highlights
Rheumatoid arthritis (RA) is a chronic systemic rheumatic inflammatory disorder predominantly affecting synovial joints
It shows that there was a significant prevalence of muscle weakness and wasting among patients in group I when compared with group II patients
There was a highly significant prevalence of increased Swindon Foot and Ankle Questionnaire (SFAQ) and Stanford Health Assessment Questionnaire Disability Index (HAQ-DI) scores (P = 0.001) among patients in group I when compared with group II patients (Table 1)
Summary
Rheumatoid arthritis (RA) is a chronic systemic rheumatic inflammatory disorder predominantly affecting synovial joints. The inflammatory response within the joint synovium leads to joint erosion, ligament laxity, and subsequent deformity. Extra-articular manifestations occur in 10–20% of patients, especially those with high titers of rheumatoid factor. Extra-articular pathology includes bursitis, tendonitis, fasciitis, neuritis, and vasculitis [1,2]. These symptoms may mimic and overlap with those of arthritis [3]. In presence of severe joint disease, restriction, pain, and deformities, symptoms of neuropathy may be overlooked or overestimated [2,4]
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