title: Musculoskeletal ultrasonography delineates ankle symptoms in rheumatoid arthritis.
abstract: OBJECTIVE
  To clarify the use of musculoskeletal ultrasonography (US) of ankle joints in rheumatoid arthritis (RA).
  
  
  METHODS
  Consecutive RA patients with or without ankle symptoms participated in the study. The US, clinical examination (CE), and patients' visual analog scale for pain (pVAS) for ankles were assessed. Prevalence of tibiotalar joint synovitis and tenosynovitis were assessed by grayscale (GS) and power Doppler (PD) US using a semi-quantitative grading (0-3). The positive US and CE findings were defined as GS score ≥2 and/or PD score ≥1, and joint swelling and/or tenderness, respectively. Multivariate analysis with the generalized linear mixed model was performed by assigning ankle pVAS as a dependent variable.
  
  
  RESULTS
  Among a total of 120 ankles from 60 RA patients, positive ankle US findings were found in 21 (35.0%) patients. The concordance rate of CE and US was moderate (kappa 0.57). Of the 88 CE negative ankles, US detected positive findings in 9 (10.2%) joints. Multivariate analysis revealed that ankle US, clinical disease activity index, and foot Health Assessment Questionnaire, but not CE, was independently associated with ankle pVAS.
  
  
  CONCLUSIONS
  US examination is useful to illustrate RA ankle involvement, especially for patients who complain ankle pain but lack CE findings.
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Toyota
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Maasa
authors.initials: M
authors.lastname: Tamura
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kirino
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Sugiyama
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Tsuchida
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kunishita
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Daiga
authors.initials: D
authors.lastname: Kishimoto
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Reikou
authors.initials: R
authors.lastname: Kamiyama
authors.affiliation: b Division of Orthopedic Science, Department of Rehabilitation Science , Kobe University Graduate School of Health Sciences , Kobe , Japan , and.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miura
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.|c Center for Rheumatic Diseases , Yokohama City University Medical Center , Yokohama , Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Minegishi
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Yoshimi
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Ueda
authors.affiliation: a Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle / Q000000981:diagnostic imaging*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D013585:Synovitis / Q000000981:diagnostic imaging*; D013717:Tenosynovitis / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Ankle joint; Power Doppler; Rheumatoid arthritis; Ultrasonography