MR IMAGING FEATURES OF FOOT INVOLVEMENT IN PATIENTS WITH BEHCET’S DISEASE

Abstract

Abstract

Objective: To determine alterations of the soft tissues, tendons, cartilage, joint spaces, and bones of the foot using magnetic resonance MR imaging in patients with Behcet’s disease BD . Materials and methods: Clinical and MR examination of the foot was performed in 25 consecutive patients 50 ft with BD. As a control group, 15 healthy volunteers 30 ft were also studied. Joint effusion/synovitis, retrocalcaneal bursitis, Achilles tendinopathy, soft-tissue edema, para-articular enthesophytes, bone marrow edema, sinus tarsi syndrome, heel fat pad edema, enthesopathy at the Achilles attachment and at the plantar fascia attachment, tenosynovitis, subchondral cysts, bone erosions, joint space narrowing, subchondral signal changes, osteolysis, luxation, and sub-luxation were examined. Results: Clinical signs and symptoms pain and swelling of foot involvement were present in 20% 5/25 of the patients while frequency of involvement was 52% 13/25 by MR imaging. The most common MR imaging findings were joint effusion/synovitis 28% , tenosynovitis 24% , retrocalcaneal bursitis 24% ,enthesopathy in the plantar fascia attachment 20% , Achilles tendinopathy 16% , sinus tarsi syndrome 16% , heel fat pad edema 16% , and soft-tissue edema 12% . The most commonly involved anatomical region was the hindfoot 36% followed by midfoot 24% , ankle 16% and forefoot 4% . Conclusion: In conclusion, in this MR imaging study, we found a high prevalence of foot involvement in BD. We believe that foot involvement, being extremely important in the differential diagnosis of rheumatic diseases tend to be overlooked. Therefore, careful examination of the foot is required in the evaluation of BD, even if the patient has no complaints

Keywords

• Behcet Syndrome,foot,MR imaging

References

1. Ghate VJ, Jorizzo JL. Behcet’s Disease. In: Kelley’s Textbook of Rheumatology. 6th ed. Philadelphia: W.B. Saunders Company;2001.pp. 1205-1209.
2. Ostergaard M, Duer A, Moller U, Ejbjerg B. Magnetic resonance imaging of peripheral joints in rheumatic diseases. Best Pract Res Clin Rheumatol 2004;18(6): 861–79.
3. Erdem CZ, Tekin NS, Sarikaya S, Erdem LO, Gulec S. MR imaging features of foot involvement in patients with psoriasis.Eur J Radiol. 2008 Sep; 67(3): 521-5. Epub 2007 Nov 9.
4. Erdem CZ, Sarikaya S, Erdem LO, Ozdolap S, Gundogdu S. MR imaging features of foot involvement in ankylosing spondylitis.Eur J Radiol. 2005 Jan; 53(1): 110-9.
5. Grigoryan M, Roemer FW, Mohr A, Genant HK. Imaging in spondyloarthropathies. Curr Rheumatol Rep 2004; 6(2):102–9.
6. Gürler A, Boyvat A, Türsen U. Clinical manifestations of Behçet's disease: an analysis of 2147 patients.Yonsei Med J. 1997 Dec; 38(6): 423-7.
7. Ho CP. Magnetic resonance imaging of the ankle and foot. Semin Roentgenol 1995; 30(3): 294–303.
8. Kim HA, Choi KW, Song YW. Arthropathy in Behcet’s disease. Scand J Rheumatol 1997; 26: 125–129.

9. Aydin G, Keleş I, Atalar E, Orkun S. Extensive erosive arthropathy in a patient with Behçet's disease: case report.Clin Rheumatol. 2005 Nov; 24(6): 645-7. Epub 2005 Jun 4.
10. Borman P, Bodur H, Bostan EE, Barca N. The coexistense of Behçet’s disease and ankylosing spondylitis. Rheumatol Int 2000;19: 195–8.
11. Kastner DL. Intermittent and periodic arthritic syndromes. In:Kopman WJ, ed. Arthritis and Allied Conditions. 14th ed. Philadelphia:Lippincott: Williams & Wilkins;2001. pp. 1400-1441.
12. Sakane T, Takeno M, Suzuki N, Inaba G. Behcet’s disease. N Engl JMed 1999;21: 1284-1291.
13. Anik Y, Ergüney AC, Müezzinoglu B, Akansel G, Demirci A. Magnetic Resonance Imaging Findings of Elbow Involvement in Behçet’s Disease: Medical Education. Turkiye Klinikleri J Med Sci 2008; 28(3): 378-81.
14. Imhof H, Nobauer-Huhmann IM, Gahleitner A, et al. Pathophysiology and imaging in inflammatory and blastomatous synovial diseases. Skeletal Radiol 2002; 31: 313–333.
15. Ostendorf B, Peters R, Dann P, et al. Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis. Arthritis Rheum 2001; 44(11): 2492–502.
16. Tehranzadeh J, Ashikyan O, Anavim A, Tramma S. Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis. Skeletal Radiol (2006) 35: 814–822.
17. Cheung Y, Rosenberg ZS, Magee T, Chinitz L. Normal anatomy and pathologic conditions of ankle tendons: current imaging techniques. Radiographics. 1992 May;12(3): 429-44.
18. Mutlu H, Sildiroglu H, Pekkafali Z, Kizilkaya E,Cermik H. MRI appearance of retrocalcaneal bursitis and rheumatoid nodule in a patient with rheumatoid arthritis. Clin Rheumatol (2006) 25: 734–736.
19. Mark E. Schweitzer and David Karasick. MR Imaging of Disorders of the Achilles Tendon. AJR 2000; 175: 613–625.
20. Beltran J. Sinus tarsi syndrome. Magn Reson Imaging Clin N Am 1994; 2(1): 59–65.
21. Akar S. Joint involvement in Behcet’s Disease. Turkiye Klinikleri J Int Med Sci 2007; 3(9).
22. Olivieri I, Salvarani C, Cantini F. Is Beh et's disease part of the spondyloarthritis complex? J Rheumatol 1997; 24: 1870-2.
23. Gökoğlu F, Ceceli E, Ramadan SU, Yorgancioglu ZR, Koşar U. Ultrasonographic evaluation of hand and foot tendons in Behçet's disease. Arch Med Res. 2008 Oct; 39(7): 709-13.
24. Mosaad YM, Metwally SS, Auf FA, et al. Proinflammatory cytokines (IL-12 and IL-18) in immune rheumatic disease: relation with disease activity and autoantibodies production. Egypt J Immunol 2003; 10: 19-26.