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Utility of power Doppler ultrasonography for detecting forefoot bursae in early rheumatoid arthritis: A case report

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Title: Utility of power Doppler ultrasonography for detecting forefoot bursae in early rheumatoid arthritis: A case report
Authors: Endo, Yushiro / Koga, Tomohiro / Eguchi, Mizuna / Okamoto, Momoko / Tsuji, Sosuke / Takatani, Ayuko / Shimizu, Toshimasa / Sumiyoshi, Remi / Igawa, Takashi / Kawashiri, Shin-ya / Iwamoto, Naoki / Ichinose, Kunihiro / Tamai, Mami / Nakamura, Hideki / Origuchi, Tomoki / Kawakami, Atsushi
Issue Date: 1-Dec-2018
Publisher: Wolters Kluwer Health, Inc.
Citation: Medicine, 97(51), e13295; 2018
Abstract: RATIONALE: Power Doppler ultrasonography (PDUS) in musculoskeletal ultrasound (MSUS) is a sensitive and reliable method for the assessment of rheumatoid arthritis (RA). The association between ultrasound-detectable forefoot bursae and the development of RA has gained attention. However, a few studies have evaluated the utility of PDUS for examining forefoot bursae in early RA. We report the case of an RA patient who developed reduced foot mobility and had detectable intermetatarsal bursitis with remarkable power Doppler (PD) signals in MSUS at the onset of RA. PATIENT CONCERNS: A 40-year-old Japanese woman diagnosed with palindromic rheumatism visited our department due to sustained forefoot pain and difficulty walking. The levels of both rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA) were high. She had opening toes with swelling in metatarsophalangeal (MTP) joints. PDUS showed intermetatarsal bursitis with mild MTP synovitis. DIAGNOSES: We diagnosed RA by comprehensive judgment based on the 2010 American College of Rheumatology and European League Against Rheumatism classification criteria for RA. INTERVENTIONS:We administered 6.0 mg/wk of methotrexate (MTX) and 2.0 mg/d of prednisolone (PSL) followed by an increase of MTX to 10 mg/wk. OUTCOMES: After those treatments, the patient's symptoms showed improvement. As of this writing,the patient's remission has been maintained for >2 months. LESSONS: Her case suggests that PDUS is useful for the detection of forefoot bursitis, and the detection of forefoot bursitis by PDUS may provide the opportunity to make an early diagnosis of RA.
Keywords: forefoot bursitis / intermetatarsal bursitis / power Doppler ultrasonography / rheumatoid arthritis
URI: http://hdl.handle.net/10069/38783
ISSN: 00257974
DOI: 10.1097/MD.0000000000013295
Rights: © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use,distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/38783

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