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Temporal Acoustic-Window Failure in Female Patients with Rheumatoid Arthritis: An Eight-Year Longitudinal Follow-Up
Attila Sas1,2, Dávid Jónyer2, Attila Valikovics2,3
1Doctoral School of Clinical Medicine, University of Debrecen, 4032 Debrecen, Hungary.
Journal of Clinical Medicine
|July 28, 2026
Summary
Temporal acoustic window status in female rheumatoid arthritis patients did not show significant progression over eight years. This finding suggests stability in the transtemporal acoustic window for neurosonography in this cohort.
Area of Science:
- Neurosonography
- Rheumatology
- Medical Imaging
Background:
- Rheumatoid arthritis (RA) is linked to increased cerebrovascular risk and altered bone metabolism.
- Adequate transtemporal acoustic window (TAW) is crucial for transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCD).
- Previous studies indicated a high frequency of temporal acoustic window failure (TAWF) in female RA patients.
Purpose of the Study:
- To evaluate the 8-year progression of binary transtemporal acoustic window (TAW) status in female rheumatoid arthritis (RA) patients.
- To assess changes in TAW status over time using neurosonographic techniques.
- To explore potential links between RA, TAW status, and cerebrovascular risk.
Main Methods:
- Follow-up study of 43 female RA patients initially assessed in 2017.
- Standardized transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCD) assessments were repeated in 2023.
- Bilateral TAW status (TAW or TAWF) was analyzed using paired transition counts and exact McNemar tests.
Main Results:
- Right-sided TAW failure (TAWF) prevalence was 37.2% and left-sided TAWF prevalence was 53.5% at both time points.
- No statistically significant progression or regression of TAW status was observed over the 8-year interval.
- Exploratory subgroup analyses by treatment (MTX, IFX, TCZ) did not reveal detectable differences in TAW status.
Conclusions:
- Binary TAW status demonstrated no detectable net progression over an 8-year period in this cohort of treated female RA patients.
- The findings do not confirm biological stability of skull sonographic permeability, and smaller changes remain possible.
- Larger studies with direct temporal bone imaging are needed to investigate mechanistic links with disease control, vitamin D, treatment, and bone remodeling.
