Investigation of the natural history of forefoot bursitis detected by musculoskeletal ultrasound and predictors of its change after one year

Bowen, Catherine J., Culliford, David, Dewbury, Keith, Sampson, Madeleine, Burridge, Jane H., Edwards, Christopher J. and Arden, Nigel K. (2009) Investigation of the natural history of forefoot bursitis detected by musculoskeletal ultrasound and predictors of its change after one year. Rheumatology, 48 (Supplement 1), 336-[i132].

Abstract

Background: inflamed bursae (bursitis) within the forefoot are highly prevalent in rheumatoid arthritis (RA), under diagnosed and impact heavily on patients’ pain, mobility and quality of life. In order to optimise the management of these patients it is essential to describe the natural history and progression of these structures over time. The objectives were to investigate whether forefoot bursitis changes over a one year period and if it does change to explore what predicts that change.
Methods: a cohort study design was used in which a sample of RA patients (N¼120 from an original baseline of N¼149) who had already been assessed at baseline were reassessed one year following their initial visit. A Diasus ultrasound system was used to image the forefeet of all participants to determine the presence and total occurrences of plantar forefoot bursitis. Foot pain was determined by both subscales of the Leeds Foot Impact Scale (LFIS), impairment/footwear (LFISIF) and activity participation limitation (LFISAP).
Results: 120 patients (98 female and 22 male) with RA (24 seronegative and 93 seropositive, 3 data missing) completed the study: mean age 60.7 (SD12.1) years, weight 72.6 (15.3) Kg, disease duration 12.99 (10.4) years. 78 (65%) were taking methotrexate and 55 (45.7%) anti-TNF therapy. Baseline and one year follow up data for clinical variables are shown in Table 1. On examination of person specific data when grouped according to occurrences of MSUS bursitis (group1: 0–2; group2: 3–6; group3: 7–11) 31 participants had an increase, 28 decrease and 61 had the same number of MSUS bursitis after one year. There was a significant positive correlation between the changes in MSUS bursitis with changes in both LFISIF (PCC¼0.216, p¼0.018) and LFISAP (PCC¼0.193, p¼0.036) and a significant negative correlation with changes in duration of RA (PCC¼0.269, p¼0.003).
Conclusions: the study findings imply that bursitis in the forefeet does change over time and remains as an important factor related to RA patients’ foot pain and disability with increases in bursitis in the forefeet being related to increases in foot pain and disability. Furthermore bursitis in the forefeet of RA patients with longer disease duration decreased after one year whilst those with early disease tended to have more variance in the changes of bursitis. This suggests that regular foot imaging assessments particularly for RA patients with early disease would be beneficial.
Disclosures: the authors have declared no conflicts of interest

This record has no associated files available for download.

Contributors

Author: Catherine J. Bowen

Author: Jane H. Burridge

Download statistics