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Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy

Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy
Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy
Background: Inhibition of tumour necrosis factor (TNF) is an effective way of reducing synovitis and preventing joint damage in rheumatoid arthritis (RA), yet very little is known about its specific effect on foot pain and disability. The aim of this study was to evaluate whether anti-TNF therapy alters the presence of forefoot pathology and/or reduces foot pain and disability.

Methods: Consecutive RA patients starting anti-TNF therapy (infliximab, etanercept, adalimumab) were assessed for presence of synovial hypertrophy and synovitis in the 2nd and 5th metatarso-phalangeal (MTP) joints and plantar forefoot bursal hypertrophy before and 12 weeks after therapy. Tender MTP joints and swollen bursae were established clinically by an experienced podiatrist and ultrasound (US) images were acquired and interpreted by a radiologist. Assessment of patient reported disease impact on the foot was performed using the Manchester Foot Pain and Disability Index (MFPDI). R

Results: 31 patients (24 female, 7 male) with RA (12 seronegative, 19 seropositive) completed the study: mean age 59.6 (SD 10.1) years, disease duration 11.1 (SD 10.5) years, and previous number of Disease Modifying Anti Rheumatic Drugs 3.0 (1.6). Significant differences after therapy were found for Erythrocyte Sedimentation Rate (t=4.014, p<0.001), C-reactive protein (t=3.889, p=0.001), 28 joint Disease Activity Score (t=3.712, p=.0.001), Visual Analog Scale (t=2.735, p=0.011) and Manchester Foot Pain and Disability Index (t=3.712, p=0.001). Presence of MTP joint synovial hypertrophy on US was noted in 67.5% of joints at baseline and 54.8% of joints at twelve weeks. Presence of plantar forefoot bursal hypertrophy on US was noted in 83.3% of feet at baseline and 75% at twelve weeks. Although there was a trend for reduction in observed presence of person specific forefoot pathology, when the frequencies were analysed (McNemar) this was not significant.

Conclusions: Significant improvements were seen in patient reported foot pain and disability 12 weeks after commencing TNF inhibition in RA, but this may not be enough time to detect changes in forefoot pathology.

1757-1146
10
Bowen, Catherine J.
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
Edwards, Christopher J.
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Lindsey, Hooper
2c8f0a88-22a8-48f0-bef5-72617ff3fb35
Dewbury, Keith
8190bf19-f678-4167-bece-d0a514d084e3
Sampson, Madeleine
e689ac99-ce4d-48d4-af7a-2a19cacb9d09
Sawyer, Sally
9a5a0dbe-11c5-49ad-98fa-8bc6e1ba48ab
Burridge, Jane H.
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Arden, Nigel K.
0f42ab7a-9e94-4f9e-aa45-20d061acab28
Bowen, Catherine J.
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
Edwards, Christopher J.
21cdd4bc-3812-4fc4-bf26-0b2908aff846
Lindsey, Hooper
2c8f0a88-22a8-48f0-bef5-72617ff3fb35
Dewbury, Keith
8190bf19-f678-4167-bece-d0a514d084e3
Sampson, Madeleine
e689ac99-ce4d-48d4-af7a-2a19cacb9d09
Sawyer, Sally
9a5a0dbe-11c5-49ad-98fa-8bc6e1ba48ab
Burridge, Jane H.
0110e9ea-0884-4982-a003-cb6307f38f64
Arden, Nigel K.
0f42ab7a-9e94-4f9e-aa45-20d061acab28

Bowen, Catherine J., Edwards, Christopher J., Lindsey, Hooper, Dewbury, Keith, Sampson, Madeleine, Sawyer, Sally, Burridge, Jane H. and Arden, Nigel K. (2010) Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy. Journal of Foot and Ankle Research, 3 (1), 10. (doi:10.1186/1757-1146-3-10). (PMID:20565792)

Record type: Article

Abstract

Background: Inhibition of tumour necrosis factor (TNF) is an effective way of reducing synovitis and preventing joint damage in rheumatoid arthritis (RA), yet very little is known about its specific effect on foot pain and disability. The aim of this study was to evaluate whether anti-TNF therapy alters the presence of forefoot pathology and/or reduces foot pain and disability.

Methods: Consecutive RA patients starting anti-TNF therapy (infliximab, etanercept, adalimumab) were assessed for presence of synovial hypertrophy and synovitis in the 2nd and 5th metatarso-phalangeal (MTP) joints and plantar forefoot bursal hypertrophy before and 12 weeks after therapy. Tender MTP joints and swollen bursae were established clinically by an experienced podiatrist and ultrasound (US) images were acquired and interpreted by a radiologist. Assessment of patient reported disease impact on the foot was performed using the Manchester Foot Pain and Disability Index (MFPDI). R

Results: 31 patients (24 female, 7 male) with RA (12 seronegative, 19 seropositive) completed the study: mean age 59.6 (SD 10.1) years, disease duration 11.1 (SD 10.5) years, and previous number of Disease Modifying Anti Rheumatic Drugs 3.0 (1.6). Significant differences after therapy were found for Erythrocyte Sedimentation Rate (t=4.014, p<0.001), C-reactive protein (t=3.889, p=0.001), 28 joint Disease Activity Score (t=3.712, p=.0.001), Visual Analog Scale (t=2.735, p=0.011) and Manchester Foot Pain and Disability Index (t=3.712, p=0.001). Presence of MTP joint synovial hypertrophy on US was noted in 67.5% of joints at baseline and 54.8% of joints at twelve weeks. Presence of plantar forefoot bursal hypertrophy on US was noted in 83.3% of feet at baseline and 75% at twelve weeks. Although there was a trend for reduction in observed presence of person specific forefoot pathology, when the frequencies were analysed (McNemar) this was not significant.

Conclusions: Significant improvements were seen in patient reported foot pain and disability 12 weeks after commencing TNF inhibition in RA, but this may not be enough time to detect changes in forefoot pathology.

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Published date: 2010
Organisations: Health Sciences

Identifiers

Local EPrints ID: 159097
URI: https://eprints.soton.ac.uk/id/eprint/159097
ISSN: 1757-1146
PURE UUID: 73c4ac69-c22c-485c-9149-dca5285d31fb
ORCID for Catherine J. Bowen: ORCID iD orcid.org/0000-0002-7252-9515
ORCID for Jane H. Burridge: ORCID iD orcid.org/0000-0003-3497-6725

Catalogue record

Date deposited: 25 Jun 2010 15:37
Last modified: 06 Jun 2018 12:59

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