Neuromuscular Ultrasound Versus Electrophysiological Studies in Assessment of Posterior Tibial Nerve Neuropathy in Rheumatoid Arthritis Patient

Abstract

Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming polyarthritis. Extra-articular manifestations occur in 10–20% of patients, especially those with high titers of rheumatoid factor. Neuromuscular ultrasound is useful for the work up of posterior tibial nerve neuropathy. Diagnosis of posterior tibial neuropathy is based on a combination of characteristic symptoms and electrophysiological abnormalities. Recently, neuromuscular ultrasound has become an attractive complement to electrodiagnostic (EDX) studies in the evaluation of peripheral nerves. Aim of the Work: To evaluate neuromuscular ultrasound versus electrophysiological studies in assessment of posterior tibial nerve neuropathy in rheumatoid arthritis patients. Patients and Methods: The subjects included in our study functionally were divided into two groups. Group (A): Thirty Egyptian patients with Rheumatoid Arthritis (RA), all fulfilled the American College of Rheumatology (ACR) 2010 criteria for diagnosis of RA and ACR criteria for classification of rheumatoid arthritis (1987). All were over the age of sixteen at time of diagnosis. They were recruited from Physical Medicine, Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from November 2017 to April 2018. They were complaining of burning pain or paresthesia on the plantar aspect of the foot and toes. Group (B): Thirty healthy individuals, age and sex matched, were used as a control group after an informed consent from all subjects. Results: Neuromuscular ultrasound had a complementary role in the diagnosis of posterior tibial nerve neuropathy. The combined use of electrophysiology with neuromuscular ultrasonography further confirmed the diagnosis of posterior tibial nerve neuropathy. Conclusion: Neuromuscular ultrasound became an attractive complement to electrodiagnostic (EDX) studies in the evaluation of posterior tibial nerve neuropathy.