The Onset of Subtalar Joint Monoarthritis in a Patient with Rheumatoid Arthritis

Abstract

The involvement of the subtalar joint is uncommon in the early stages of rheumatoid arthritis (RA). We report a case of a 47-year-old female who had RA with isolated subtalar joint arthritis. The clinical history, magnetic resonance imaging, and pathological findings of the patient are presented. A careful evaluation of the patients for chronic ankle-to-heel pain should be conducted, and concomitant evaluation for inflammatory arthritis, including RA, should be considered.

Keywords: monoarthritis; rheumatoid arthritis; subtalar joint.

Figure 1

Subtalar joint involvement in a 47-year-old female. Anteroposterior (a) and lateral (b) plain radiographs of the right ankle joint. Coronal T1-weighted (c), sagittal T1-weighted (d), coronal fat-suppressed T2-weighted (e), and sagittal fat-suppressed T2-weighted (f) images of the right ankle joint using magnetic resonance imaging (MRI). MRI images show a moderate subtalar joint effusion with bone marrow edema.

Figure 2

Subtalar joint showing progressive involvement 1 year later. Coronal T1-weighted (a), sagittal T1-weighted (b), coronal fat-suppressed T2-weighted (c), and sagittal fat-suppressed T2-weighted (d) images of the right ankle joint. Findings show a marked loss of articular cartilage with associated bone marrow edema in the subarticular region of the subtalar joint and bone marrow edema of the tibiotalar joint.

Figure 3

Erosion and destruction of the subtalar joint on computed tomography. Computed tomography images of the coronal (a), sagittal (b), and axial (c) parts of the subtalar joint. Findings demonstrate narrowed joint space and destruction of the subtalar joint of the right ankle.

Figure 4

Surgical biopsy specimen of the subtalar joint region shows synovial proliferation and lymphocytes in the synovium (a). Proliferation of synovial lining cells, vascular proliferation, and lymphocyte infiltrate can be observed in the synovium (b).