To the Editors:

We read with interest the article published in Arthritis Care & Research by Sheane et al on the value of examining by ultrasonography (US) the fifth metatarsophalangeal (MTP) joint for the early diagnosis of rheumatoid arthritis (RA) (1). We fully agree with Sheane et al on the value of examining this joint in patients suspected of having RA. We were, however, surprised that our previously published work was not included on their reference list. Our work indicates that erosive disease was most commonly seen in the fifth MTP of all joints (2). US of the feet revealed erosive changes in 3 patients who had negative US of their hands. One of these patients had no evidence of erosive disease in any of the other joints of the hands or feet usually assessed by radiography. The table included in our previous publication provides the specific numbers.

  • 1
    Sheane BJ, Beddy P, O'Connor M, Miller S, Cunnane G. Targeted ultrasound of the fifth metatarsophalangeal joint in an early inflammatory arthritis cohort. Arthritis Rheum 2009; 61: 10048.
  • 2
    Lopez-Ben R, Bernreuter WK, Moreland LW, Alarcon GS. Ultrasound detection of bone erosions in rheumatoid arthritis: a comparison to routine radiographs of the hands and feet. Skeletal Radiol 2004; 33: 804.

Graciela S. Alarcón MD, MPH*, Robert Lopez-Ben MD*, * University of Alabama at Birmingham.