Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis

BMC Musculoskeletal Disorders

Research Article

Richard J Hodgson¹  Philip S Helliwell²  Heidi J Siddle³  Richard J Wakefield³  Elizabeth M A Hensor³  Anthony C Redmond³  Andrew J Grainger⁴ 

[1] Centre for Imaging Sciences, University of Manchester, Oxford Road, M13 9PL, Manchester, UK;Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, LS7 4SA, Leeds, UK;Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, LS7 4SA, Leeds, UK;NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, LS7 4SA, Leeds, UK;NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, LS7 4SA, Leeds, UK;Department of Radiology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, LS7 4SA, Leeds, UK;

关键词: Rheumatoid arthritis;    Foot;    Metatarsophalangeal joint;    Erosion;    Magnetic resonance imaging;    Plantar plate;   

DOI  :  10.1186/s12891-017-1668-0

 received in 2016-12-10, accepted in 2017-07-10,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDisease-related foot pathology is recognised to have a significant impact on mobility and functional capacity in the majority of patients with rheumatoid arthritis (RA). The forefoot is widely affected and the metatarsophalangeal (MTP) joints are the most common site of symptoms. The plantar plates are the fibrocartilaginous distal attachments of the plantar fascia inserting into the five proximal phalanges. Together with the transverse metatarsal ligament they prevent splaying of the forefoot and subluxation of the MTP joints. Damage to the plantar plates is a plausible mechanism therefore, through which the forefoot presentation, commonly described as ‘walking on pebbles’, may develop in patients with RA.The aims of this study were to investigate the relationship between plantar plate pathology and clinical, biomechanical and plain radiography findings in the painful forefoot of patients with RA. Secondly, to compare plantar plate pathology at the symptomatic lesser (2nd-5th) MTP joints in patients with RA, with a group of healthy age and gender matched control subjects without foot pain.MethodsIn 41 patients with RA and ten control subjects the forefoot was imaged using 3T MRI. Intermediate weighted fat-suppressed sagittal and short axis sequences were acquired through the lesser MTP joints. Images were read prospectively by two radiologists and consensus reached. Plantar plate pathology in patients with RA was compared with control subjects. Multivariable multilevel modelling was used to assess the association between plantar plate pathology and the clinical, biomechanical and plain radiography findings.ResultsThere were significant differences between control subjects and patients with RA in the presence of plantar plate pathology at the lesser MTP joints. No substantive or statistically significant associations were found between plantar plate pathology and clinical and biomechanical findings. The presence of plantar plate pathology was independently associated with an increase in the odds of erosion (OR = 52.50 [8.38–326.97], p < 0.001).ConclusionThe distribution of plantar plate pathology at the lesser MTP joints in healthy control subjects differs to that seen in patients with RA who have the consequence of inflammatory disease in the forefoot. Longitudinal follow-up is required to determine the mechanism and presentation of plantar plate pathology in the painful forefoot of patients with RA.

【 授权许可】

CC BY   
© The Author(s). 2017