Abstract：
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease affecting not only the synovial joints but also multiple extra-articular sites, including ankle and foot soft tissue. Hindfoot abnormalities usually follow those in the forefoot, with up to 4 out of 10 patients experiencing talalgia during their disease course. Enthesophytosis, retrocalcaneal bursitis, and plantar fasciitis are among the most common etiologies, while heel fat pad abnormalities like subcalcaneal bursitis are rare. Here, we report two cases of subcalcaneal bursitis, and the first case of heel fat pad and subcalcaneal bursa herniation in patients with established RA, along with a comprehensive literature review of subcalcaneal bursitis and other heel fat pad abnormalities in RA. Subcalcaneal bursitis, also referred to as panniculitis, inflammatory-edematous lesion, or adventitial (adventitious) bursitis has been reported in up to 10% of patients with RA. It appears as a compressible, heterogeneous, and hypoechoic subcalcaneal mass on ultrasound (US), with peripheral vascularization on Doppler US. Patients may present with heel discomfort. Ultrasonographic assessment is usually sufficient to confirm the presence of heel fat pad pathologies. Rest, analgesics, and mechanical aids with or without addition of disease-modifying antirheumatic drugs are usually employed, while intervention is rarely required.
摘要：
类风湿性关节炎（RA）是一种慢性自身免疫性炎性疾病，不仅影响滑膜关节，而且影响多个关节外部位，包括脚踝和足部软组织。后脚异常通常跟随前脚，10名患者中有多达4名在病程中经历距骨疼痛。胃生效应,跟骨后滑囊炎,足底筋膜炎是最常见的病因，而跟骨滑囊炎等跟跟骨脂肪垫异常很少见。这里,我们报告2例跟骨下滑囊炎,和第一例足跟脂肪垫和跟骨囊下疝在RA患者中，并对RA的跟骨下滑囊炎和其他足跟脂肪垫异常进行了全面的文献综述。跟骨下滑囊炎,也被称为脂膜炎，炎性水肿性病变，据报道，多达10％的RA患者出现外膜（不定）滑囊炎。它看起来是可压缩的，异质，超声检查（US）和跟骨下低回声肿块，在多普勒超声上有外周血管形成。患者可能出现足跟不适。超声检查通常足以确认脚跟脂肪垫病变的存在。休息,镇痛药,和机械辅助与或不添加疾病缓解抗风湿药物通常使用，虽然很少需要干预。
