Ultrasound imaging of the dorsalis pedis artery as an early indicator of the precursory changes for rheumatoid vasculitis: A case series

Robyn Boman, Stefania Penkala, Rosa H. M. Chan, Fredrick Joshua, Roy Tsz Hei Cheung
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Abstract

Introduction

Clinical verification of rheumatoid vasculitis (RV) persists as a mid-to-late diagnosis with medical imaging or biopsy. Early and subclinical presentations of RV, in particular, can remain underdiagnosed in the absence of adequate diagnostic testing. In this study, the research demonstrated the precursory changes for RV in patients with rheumatoid arthritis (RA) using non-invasive ultrasound imaging of a peripheral vessel.

Method

Six participants were recruited: three participants with (RA) and three age- and gender-matched healthy controls. All participants completed a Foot Health Survey Questionnaire (FHSQ), and participants with RA completed a Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5). Bilateral B-mode and Doppler ultrasound of the dorsalis pedis artery (DPA) was performed. The degree of inflammation, lumen and artery diameters, lumen diameter-to-artery diameter ratio and peak systolic velocity in the proximal DPA were compared between the two groups.

Results

The mean RADAI-5 score (5.4 ± 0.8 out of 10) indicated moderate disease activity amongst participants with RA. Inflammation was observed in the DPA wall in all participants with RA, compared to no inflammation observed in the control group (Friedmans two-way analysis: χ2 = 15.733, P = 0.003). Differences between groups for inflammation, lumen diameter and lumen diameter-to-artery diameter ratio were found (P < 0.034), without differences for artery diameter and peak systolic velocity (P > 0.605). DPA wall inflammation did not correlate with FHSQ scores (r = −0.770, P = 0.073).

Conclusion

Despite moderate RA disease activity, this is the first study to demonstrate the use of ultrasound to observe inflammation in small vessel disease. Our findings suggest ultrasound imaging may be a viable screening tool to demonstrate arterial wall inflammation, indicating the precursory changes of RV.

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足背动脉超声成像是类风湿血管炎前兆变化的早期指标:病例系列
类风湿性血管炎(RV)的临床验证一直是医学影像或活检的中晚期诊断。特别是早期和亚临床表现的类风湿血管炎,在缺乏适当诊断测试的情况下,可能仍然诊断不足。在这项研究中,研究人员利用外周血管的非侵入性超声波成像技术,证明了类风湿性关节炎(RA)患者RV的前兆变化。所有参与者都填写了足部健康调查问卷(FHSQ),类风湿性关节炎患者填写了类风湿性关节炎疾病活动指数-5(RADAI-5)。对双侧足背动脉(DPA)进行了B型和多普勒超声检查。两组患者的炎症程度、管腔和动脉直径、管腔直径与动脉直径之比以及近端 DPA 收缩速度峰值进行了比较。RADAI-5 平均得分(5.4 ± 0.8,满分为 10 分)表明 RA 患者的疾病活动度为中度。所有RA患者的DPA壁均出现炎症,而对照组无炎症(Friedmans双向分析:χ2 = 15.733,P = 0.003)。炎症、管腔直径和管腔直径与动脉直径比值在组间存在差异(P 0.605)。DPA管壁炎症与FHSQ评分无相关性(r = -0.770,P = 0.073)。尽管RA疾病活动度中等,但这是第一项利用超声观察小血管疾病炎症的研究。我们的研究结果表明,超声成像可能是显示动脉壁炎症的一种可行的筛查工具,可显示RV的前兆变化。
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来源期刊
Australasian Journal of Ultrasound in Medicine
Australasian Journal of Ultrasound in Medicine Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
1.90
自引率
0.00%
发文量
40
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