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

doi:10.1002/ajum.12373

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

Australas J Ultrasound Med. 2023 Dec 17;27(1):42-48. doi: 10.1002/ajum.12373. eCollection 2024 Feb.

Authors

Robyn Boman¹, Stefania Penkala^{1

2}, Rosa H M Chan³, Fredrick Joshua⁴, Roy Tsz Hei Cheung^{1

2}

Affiliations

¹ School of Health Sciences Western Sydney University Campbelltown New South Wales Australia.
² Translational Health Research Institute Western Sydney University Campbelltown New South Wales Australia.
³ Department of Electrical Engineering City University of Hong Kong Hong Kong Hong Kong.
⁴ Faculty of Medicine and Health Sciences Macquarie University Sydney New South Wales Australia.

PMID: 38434542
PMCID: PMC10902827 (available on 2024-12-17)
DOI: 10.1002/ajum.12373

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.

Keywords: adventitia; blood vessels; inflammation; intima; rheumatology.