MAGNETIC-RESONANCE-IMAGING OF ACHILLES-TENDON IN PATIENTS WITH RHEUMATOID-ARTHRITIS

RATIONALE AND OBJECTIVES. The authors characterize the appearance of t he Achilles tendon in patients with rheumatoid arthritis and different iate this appearance from degenerative tendinopathy in patients with c hronic pain of the heel using magnetic resonance (MR) imaging, METHODS . Thirty patients with rheumatoid arthritis and 28 patients with chron ic pain of the heel underwent MR imaging of the ankle and foot, Three radiologists independently assessed the MR images with respect to size , shape, and intratendinal signal characteristics of the Achilles tend on, The Achilles tendon was considered abnormal on MR imaging when int ratendinous signal alterations or an anteroposterior measurement great er than 8 mm was seen, Physical examination of the Achilles tendons wa s accomplished in both groups, Operation confirmed the diagnosis of 13 patients in the second group with chronic pain of the heel, RESULTS. The Achilles tendon of 83% of patients with rheumatoid arthritis demon strated various intratendinous patterns (longitudinal, reticular, nodu lar) of intermediate signal intensity on all pulse sequences on MR ima ging, Ninety percent of patients with rheumatoid tendinopathy showed n o enlargement of the anteroposterior diameter of the Achilles tendon, In addition, all patients with rheumatoid arthritis had findings compa tible with an inflammation of the retrocalcaneal bursa on MR imaging, whereas none of the patients with tendinopathy associated with chronic heel pain had retrocalcaneal bursitis, All patients, however, had enl argement of the anteroposterior diameter of the Achilles tendon, Seven ty-nine percent showed various intratendinous lesions of intermediate signal intensity on all pulse sequences. Twenty-one percent of patient s had an enlargement of the Achilles tendon without intratendinous cha nges, CONCLUSIONS. Rheumatoid tendinopathy can be distinguished from d egenerative tendinopathy in patients with chronic pain of the heel wit h MR imaging, Inflammation of the retrocalcaneal bursa and the absence of enlargement of the tendon combined with the presence of intratendi nous signal alterations are characteristic findings of rheumatoid tend inopathy.