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Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study

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Abstract

Foot involvement is a major feature of rheumatoid arthritis (RA). Most epidemiological studies of the RA foot report radiological changes and results of clinical examination. This study aimed to determine the prevalence of foot symptoms, frequency of foot assessment and access to foot care from the perspective of people with RA. A questionnaire was sent to 1,040 people with RA throughout the UK enquiring about foot symptoms, their anatomical distribution (via validated mannequins) availability of podiatry services and perceived usefulness of interventions for alleviating foot symptoms. Altogether 585 useable replies were received; 93.5% of respondents reported having experienced foot pain, and 35.4% reported current foot pain as the presenting symptom. Most (68.2%) reported moderate or severe foot pain daily. Pain was most prevalent in the forefoot and/or ankle. The main predictive factors for reporting current foot pain were longer disease duration (mean 13 vs 10.3 years, p = 0.009), higher BMI (25.6 vs 24.1 p = 0.001) and the prevalent foot symptoms foot stiffness and numbness (both p < 0.0001). Age, gender and current treatment were not significantly associated. Most (82%) had discussed foot symptoms with their rheumatologist, and only 64% had seen a podiatrist. Reported current adherence to prescribed orthoses was 55.8% and to prescribed shoes was 29.5%. Foot symptoms are ubiquitous in RA and frequently severe. Most patients had discussed their symptoms with their rheumatologist, and only 64% had specifically seen a podiatrist. Despite the remarkable progress in development of new treatment modalities for RA, foot pain remains a common and disabling symptom. Our findings support the need for wider access to specific foot care services and evidence-based, patient-centred interventions.

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References

  1. Vainio K (1956) The rheumatoid foot. Annales Chirurgiae et Gynaecologiae Fenniae 45(Suppl 1):1–107

    CAS  Google Scholar 

  2. Matricali GA, Boonen A, Verduyckt J, Taelman V, Verschueren P, Sileghem A, Corluy L, Westhovens R (2006) The presence of forefoot problems and the role of surgery in patients with rheumatoid arthritis. Ann Rheum Dis 65(9):1254–1255

    Article  CAS  PubMed  Google Scholar 

  3. Turner DE, Helliwell PS, Emery P, Woodburn J (2006) The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskeletal Dis 7:102–110

    Article  Google Scholar 

  4. Lohkamp M, Burrow G, McCarron T, Maclaren W, Granat M (2006) The prevalence and anatomical location of foot pain in early diagnosed patients with rheumatoid arthritis. Br J Podiatry 9(4):115–119

    Google Scholar 

  5. Spiegel TM, Spiegel JS (1982) Rheumatoid arthritis in the foot and ankle—diagnosis, pathology and treatment: the relationship between foot and ankle deformity and disease duration in 50 patients. Foot Ankle 2(6):318–324

    CAS  PubMed  Google Scholar 

  6. Michelson J, Easley M, Wigley FM, Hellman D (1994) Foot and ankle problems in rheumatoid arthritis. Foot Ankle 15(11):608–613

    CAS  PubMed  Google Scholar 

  7. Vidigal EC (1978) Forefoot in chronic arthritis. Orthop Rev 7(1):43–46

    Google Scholar 

  8. Shi K, Tomita T, Hayashida K, Owaki H, Ochi T (2000) Foot deformities in rheumatoid arthritis and relevance of disease severity. Foot J Rheumatol 27(1):8–9

    Google Scholar 

  9. Grondal L, Tengstrand B, Nordmark B, Wretenberg P, Stark A (2008) The foot: still the most important reason for walking incapacity in rheumatoid arthritis: distribution of symptomatic joints in 1, 000 RA patients. Acta Orthop 79(2):257–261

    Article  PubMed  Google Scholar 

  10. Bann CM, Fehnel SE, Gagnon DD (2003) Development and validation of the diabetic foot ulcer scale-short form (DFS-SF). Pharmacoeconomics 21(17):1277–1290

    Article  PubMed  Google Scholar 

  11. Garrow AP, Papageorgiou AC, Silman AJ et al (2000) Development and validation of a questionnaire to assess disabling foot pain. Pain 85:107–113

    Article  CAS  PubMed  Google Scholar 

  12. Aletaha D (2006) Pooled indicies to measure rheumatoid arthritis activity: a good reflection of the physician’s mind? Arthritis Res Ther 8(1):102

    Article  PubMed  Google Scholar 

  13. Aletaha D, Machold KP, Nell VP, Smolen JS (2006) The perception of rheumatoid arthritis core set measures by rheumatologists. Results of a survey. Rheumatology (Oxford) 45(9):1133–1139

    Article  CAS  Google Scholar 

  14. Prevoo ML, van t’Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PLCM (1995) Modified disease activity scores that indicate twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38(1):44–48

    Article  CAS  PubMed  Google Scholar 

  15. Leeb BF, Andel I, Leder S, Leeb BA, Rintelen B (2005) The patient’s perspective and rheumatoid arthritis disease activity indexes. Rheumatology 44(3):360–365

    Article  CAS  PubMed  Google Scholar 

  16. Landewé R, van der Heijde D, van der Linden S, Boers M (2006) Twenty-eight-joint counts invalidate the DAS 28 remission owing to the omission of the lower extremity joints: a comparison with the original DAS remission. Ann Rheum Dis 65(5):637–641

    Article  PubMed  Google Scholar 

  17. Katz PP, Morris A, Yelin EH (2006) Prevalence and predictors of disability in valued life activities among individuals with rheumatoid arthritis. Ann Rheum Dis 65(6):763–769

    Article  CAS  PubMed  Google Scholar 

  18. Kavlak Y, Uygur F, Korkmaz C, Bek N (2003) Outcome of orthoses intervention in the rheumatoid foot. Foot Ankle Int 24(6):494–499

    PubMed  Google Scholar 

  19. Woodburn J, Barker S, Helliwell PS (2002) A randomised controlled trial of foot orthoses in rheumatoid arthritis. J Rheumatol 29(7):1377–1383

    PubMed  Google Scholar 

  20. Kerry RM, Holt GM Stockley I (1994) The foot in chronic rheumatoid arthritis; a continuing problem. Foot 4:201–203

    Article  Google Scholar 

  21. Donnan PT, MacDonald TM, Morris AD (2002) Adherence to prescribed oral hypoglycaemic medication in a population of patients with Type 2 diabetes: a retrospective cohort study. Diabet Med 19(4):279–284

    Article  CAS  PubMed  Google Scholar 

  22. Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J (2002) Long-term persistence in use of statin therapy in elderly patients. J Am Med Assoc 288(4):455–461

    Article  Google Scholar 

  23. Fransen M, Edmonds J (1997) Off-the-shelf orthopaedic footwear for people with rheumatoid arthritis. Arthritis Care Res 10(4):250–256

    Article  CAS  PubMed  Google Scholar 

  24. Williams AE, Rome K, Nester CJ (2007) A clinical trial of specialist footwear for patients with rheumatoid arthritis. Rheumatology (Oxford) 46:302–307

    Article  CAS  Google Scholar 

  25. de Magalhaes EP, Davitt M, Filho DJ, Battistella LR, Bertolo MB (2006) The effect of foot orthoses in rheumatoid arthritis. Rheumatology (Oxford) 45:449–453

    Article  Google Scholar 

  26. Egan M, Brosseau L, Farmer M, Ouimet MA, Rees S, Wells G, Tugwell P (2001) Splints and orthoses for treating rheumatoid arthritis. The Cochrane Database of systematic reviews Issue 4 Art, No CD004018. doi:10.1002/14651858.CD004018

  27. Williams AE (2006) Patient perceptions of stock footwear design features. Prosthet Orthot Int 30(1):61–71

    Article  CAS  PubMed  Google Scholar 

  28. Helliwell PS (2003) Lessons to be learned: review of a multi-disciplinary foot clinic in rheumatology. Rheumatology (Oxford) 42(11):1426–1427

    Article  CAS  Google Scholar 

  29. Redmond AC, Waxman R, Helliwell PS (2006) Provision of foot health services in rheumatology in the UK. Rheumatology (Oxford) 45(5):571–576

    Article  CAS  Google Scholar 

  30. Walker-Bone K, Reading I, Coggon D, Cooper C, Palmer KT (2004) The anatomical pattern and determinants of pain in the neck and upper limbs: an epidemiologic study. Pain 109(1–2):45–51

    Article  PubMed  Google Scholar 

  31. Jordan KM, Sawyer S, Coakley P, Smith HE, Cooper C, Arden NK (2004) The use of conventional and complementary treatment for knee osteoarthritis in the community. Rheumatology (Oxford) 43(3):381–384

    Article  CAS  Google Scholar 

  32. Arthritis and Musculoskeletal Alliance (ARMA) (2004) Standards of care for people with inflammatory arthritis. www.arma.uk.net/pdfs/ia06

  33. National Institute for Health and Clinical Excellence (NICE) 2009 NICE clinical guideline 79—rheumatoid arthritis. www.NICE.org.uk/CG79

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Acknowledgements

The authors wish to thank the National Rheumatoid Arthritis Society for their support, those who took the time to complete a questionnaire and the research assistants for their help with running the project.

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None.

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Authors and Affiliations

  1. School of Health Professions, University of Brighton, Robert Dodd Building, 49 Darley Rd, Eastbourne, BN20 7UR, UK

    Simon J. Otter, Kevin Lucas & Ann Moore

  2. Department of Allied Health Professions, Canterbury Christ Church University, Canterbury, UK

    Kate Springett

  3. Brighton & Sussex Medical School, Brighton & Sussex, UK

    Kevin Davies & Karen Walker-Bone

  4. Computing Mathematical and Information Sciences, University of Brighton, Brighton & Sussex, UK

    Liz Cheek

  5. Rheumatology Department, North West Herts NHS Trust, Hertfordshire, UK

    Adam Young

Authors
  1. Simon J. Otter
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  2. Kevin Lucas
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  3. Kate Springett
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  4. Ann Moore
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  5. Kevin Davies
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  6. Liz Cheek
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  7. Adam Young
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  8. Karen Walker-Bone
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Correspondence to Simon J. Otter.

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Otter, S.J., Lucas, K., Springett, K. et al. Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study. Clin Rheumatol 29, 255–271 (2010). https://doi.org/10.1007/s10067-009-1312-y

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  • DOI: https://doi.org/10.1007/s10067-009-1312-y

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