Neuropathic Foot and Ankle in Rheumatoid Arthritis : Ultrasound and Nerve Conduction Study

Study Overview
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Brief Summary
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To measure the prevalence of Neuropathic pain in Rheumatoid arthritis patients with ankle and foot pain To evaluate the role of Neuromuscular Ultra sound (NMUS) and nerve conduction study (NCS) in assessment of Neuropathic foot and ankle in Rheumatoid arthritis patients

Detailed Description
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Rheumatoid arthritis (RA) is a common chronic systemic autoimmune disease that primarily affects the lining of the synovial joints which symmetrically involves the small joints, can cause cartilage and bone damage and associated with progressive disability, premature deaths, and socioeconomic burdens . In RA, neuropathic pain which is defined as pain caused by a lesion or a disease of the somatosensory system , could be suggested by :nerve compression, associated comorbidities and vascuilitis . Despite the recent advancement in RA treatment, neuropathic pain remains a cause of persistent pain even in controlled disease activity. The prevalence of clinical neuropathy varies from 0.5% to 85% in patients with RA, which can cause functional disability . Foot and ankle pain is highly prevalent in RA with peripheral neuropathy is a common contributor to it . In previous studies , it was found that the most foot neuropathies are of tarsal tunnel syndrome, peroneal nerve entrapment and pure sensory axonal neuropathy. For evaluation of neuropathic foot and ankle in RA , electrophysiological and imaging techniques can be very useful. Nerve conduction study (NCS) is the electrodiagnostic evaluation of the function of peripheral nerves ,it can provide information regarding the presence, severity and location of a lesion, symmetricity of neuropathy, mononeuropathy or disorders affecting the neuromuscular junctions. Also, the functional modality most involved (sensory or motor) and the predominant pattern of pathology (e.g., axonal, demyelinating, or both. Neuromascular ultrasond(NMUS) is a new modality of diagnosis developed in the past 20 years , and it can assess anatomical abnormalities that can't be evaluated by NCS NMUS being noninvasive and inexpensive diagnostic modality , it has been introduced as a complement to NCS for diagnosis of nerve conditions.

Official Title
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Neuropathic Foot and Ankle in Rheumatoid Arthritis : Ultrasound and Nerve Conduction Study

Conditions
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Rheumatoid Arthritis

Intervention / Treatment
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* Diagnostic Test: neuromascular ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults aged ≥ 18 years. RA patients who fulfilled the 2010 ACR/European league against Rheumatism(EULAR) criteria for the classification of RA RA patients complaining of foot and ankle pain Exclusion Criteria: Presence of other autoimmune disorders Presence of any comorbidities causing neuropathy as Diabetes Mellitus, disc prolapse

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: neuromascular ultrasound|neuromascular ultrasound of foot and ankle|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ultrasound parameters | nerve cross-section | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| nerve conduction parameters | nerve distal latency | 3 years | 
| painDETECT questionnaire | screening for neuropathic pain | 1 year |