The University of Southampton
University of Southampton Institutional Repository

Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: a twelve-month investigation

Bowen, Catherine J., Hooper, Lindsey, Dewbury, Keith, Sampson, Madeline, Burridge, Jane, Edwards, Christopher J. and Arden, Nigel K. (2010) Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: a twelve-month investigation Arthritis Care and Research, 62, (12), pp. 1756-1762. (doi:10.1002/acr.20326). (PMID:20722046).

Record type: Article


Objective: To determine the natural history and clinical significance of forefoot bursae over a 12-month period in patients with rheumatoid arthritis (RA).

Methods: Patients with RA (n = 149) attending rheumatology outpatient clinics were assessed at baseline. A total of 120 participants, mean ± SD age 60.7 ± 12.1 years and mean ± SD disease duration 12.99 ± 10.4 years, completed the 12-month followup (98 women, 22 men, 93 rheumatoid factor positive, 24 rheumatoid factor negative, and 3 unknown). Musculoskeletal ultrasound (US) was used to identify forefoot bursae in all of the participants. Clinical markers of disease activity (well-being visual analog scale [VAS], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] level, and Disease Activity Score in 28 joints [DAS28]) and foot symptoms on the Leeds Foot Impact Scale (LFIS) Questionnaire were recorded on both occasions.

Results: Presence of US-detectable forefoot bursae was identified in 93.3% of returnee (n = 120) participants (individual mean 3.7, range 0–11) at baseline. Significant associations were identified between bursae presence and patient-reported foot impact for impairment/footwear (LFISIF; baseline: r = 0.226, P = 0.013 and 12 months: r = 0.236, P = 0.009) and activity limitation/participation restriction (LFISAP; baseline: r = 0.254, P = 0.005 and 12 months: r = 0.235, P = 0.010). After 12 months, 42.5% of participants had an increase in the number of US-detectable forefoot bursae and 45% of participants had a decrease. Changes in bursae number significantly correlated with changes in LFISIF (r = 0.216, P = 0.018) and LFISAP (r = 0.193, P = 0.036). No significant associations were identified between changes in bursae and changes in global well-being VAS, ESR, CRP level, or DAS28.

Conclusion: The findings of this study suggest that forefoot bursae may regress or hypertrophy over time in patients with RA, and that these changes may be associated with self-reported foot impairment and activity restriction.

PDF Natural_history_of_bursae_in_forefoot_in_RA_ACR[2].pdf - Author's Original
Restricted to Registered users only
Download (52kB)

More information

Published date: 2010
Organisations: Medicine


Local EPrints ID: 174789
PURE UUID: b14299d2-9d84-444d-a787-adeb44d5bef6
ORCID for Catherine J. Bowen: ORCID iD
ORCID for Lindsey Hooper: ORCID iD
ORCID for Jane Burridge: ORCID iD

Catalogue record

Date deposited: 16 Feb 2011 16:12
Last modified: 18 Jul 2017 12:10

Export record



Author: Lindsey Hooper ORCID iD
Author: Keith Dewbury
Author: Madeline Sampson
Author: Jane Burridge ORCID iD
Author: Nigel K. Arden

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.