The authors characterize the appearance of the Achilles tendon in patients with rheumatoid arthritis and differentiate this appearance from degenerative tendinopathy in patients with chronic pain of the heel using magnetic resonance (MR) imaging.
Thirty patients with rheumatoid arthritis and 28 patients with chronic 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 tendon. The Achilles tendon was considered abnormal on MR imaging when intratendinous signal alterations or an anteroposterior measurement greater than 8 mm was seen. Physical examination of the Achilles tendons was accomplished in both groups. Operation confirmed the diagnosis of 13 patients in the second group with chronic pain of the heel.
The Achilles tendon of 83% of patients with rheumatoid arthritis demonstrated various intratendinous patterns (longitudinal, reticular, nodular) of intermediate signal intensity on all pulse sequences on MR imaging. Ninety percent of patients with rheumatoid tendinopathy showed no enlargement of the anteroposterior diameter of the Achilles tendon. In addition, all patients with rheumatoid arthritis had findings compatible 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 enlargement of the anteroposterior diameter of the Achilles tendon. Seventy-nine percent showed various intratendinous lesions of intermediate signal intensity on all pulse sequences. Twenty-one percent of patients had an enlargement of the Achilles tendon without intratendinous changes.
Rheumatoid tendinopathy can be distinguished from degenerative tendinopathy in patients with chronic pain of the heel with MR imaging. Inflammation of the retrocalcaneal bursa and the absence of enlargement of the tendon combined with the presence of intratendinous signal alterations are characteristic findings of rheumatoid tendinopathy.