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Prognostic indicators of foot related disability in patients with RA: results of a prospective three-year study

Prognostic indicators of foot related disability in patients with RA: results of a prospective three-year study
Prognostic indicators of foot related disability in patients with RA: results of a prospective three-year study
Objective:
To determine the prevalence and natural history of foot-related disability in patients with RA. A secondary aim was to identify explanatory variables, including forefoot bursae, which are either associated with or predictive of disabling foot complications in patients with RA.
Methods:
A longitudinal, prospective, cohort study recruited patients with RA from a rheumatology outpatient clinic. Data were collected at baseline (N=149), one-year (n=120) and three-year follow-up (n=60). Patient-reported disabling foot complications were evaluated using the subscales of the Foot Impairment Score; foot impairment/ footwear restriction (FISIF) & activity limitation/participation restriction (FISAP). Explanatory variables investigated included ultrasound detectable forefoot pathology and markers of disease activity.
Results:
Disabling foot complications were highly prevalent on all occasions. Changes in foot impairment and activity limitation were significantly associated with fluctuations in disease activity (FISIF: DAS28-ESR r=0.455, p<0.0001; ESR r=-0.356, p=0.008, FISAP: DAS28-ESR r=0.433, p=0.001; ESR r=-0.439, p=0.001), and approaching a significant association with changes in forefoot bursae (FISIF: r=0.255, p=0.063; FISAP: r=0.255, p=0.063). Disease duration and forefoot bursae presence were significant prognostic indicators of foot impairment (p=0.009, p=0.012 respectively), explaining 16% of score variability in the final regression model. Disease duration, forefoot bursae and erosion presence were identified as significant prognostic indicators of activity limitation (p=0.006, p=0.019, p=0.002 respectively), explaining 35% of score variability in the final regression model.
Conclusion:
Despite advances in disease management, patients report disability associated with foot problems. Forefoot bursae should be considered for targeted therapy
arthritis, rheumatoid, foot, impairment, activity limitation, disability, bursa
0004-3591
1116-1124
Hooper, L.
95256156-ce8c-4e7c-b04d-b6e459232441
Bowen, C.J.
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Gates, L.
bc67b8b8-110b-4358-8e1b-6f1d345bd503
Culliford, D.J.
25511573-74d3-422a-b0ee-dfe60f80df87
Ball, C.
e3c95e80-c831-4f74-945b-be79abe093c7
Edwards, C.J.
dcb27fec-75ea-4575-a844-3588bcf14106
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Hooper, L.
95256156-ce8c-4e7c-b04d-b6e459232441
Bowen, C.J.
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
Gates, L.
bc67b8b8-110b-4358-8e1b-6f1d345bd503
Culliford, D.J.
25511573-74d3-422a-b0ee-dfe60f80df87
Ball, C.
e3c95e80-c831-4f74-945b-be79abe093c7
Edwards, C.J.
dcb27fec-75ea-4575-a844-3588bcf14106
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f

Hooper, L., Bowen, C.J., Gates, L., Culliford, D.J., Ball, C., Edwards, C.J. and Arden, N.K. (2012) Prognostic indicators of foot related disability in patients with RA: results of a prospective three-year study. Arthritis & Rheumatism, 64 (8), 1116-1124. (doi:10.1002/acr.21672). (PMID:22422621)

Record type: Article

Abstract

Objective:
To determine the prevalence and natural history of foot-related disability in patients with RA. A secondary aim was to identify explanatory variables, including forefoot bursae, which are either associated with or predictive of disabling foot complications in patients with RA.
Methods:
A longitudinal, prospective, cohort study recruited patients with RA from a rheumatology outpatient clinic. Data were collected at baseline (N=149), one-year (n=120) and three-year follow-up (n=60). Patient-reported disabling foot complications were evaluated using the subscales of the Foot Impairment Score; foot impairment/ footwear restriction (FISIF) & activity limitation/participation restriction (FISAP). Explanatory variables investigated included ultrasound detectable forefoot pathology and markers of disease activity.
Results:
Disabling foot complications were highly prevalent on all occasions. Changes in foot impairment and activity limitation were significantly associated with fluctuations in disease activity (FISIF: DAS28-ESR r=0.455, p<0.0001; ESR r=-0.356, p=0.008, FISAP: DAS28-ESR r=0.433, p=0.001; ESR r=-0.439, p=0.001), and approaching a significant association with changes in forefoot bursae (FISIF: r=0.255, p=0.063; FISAP: r=0.255, p=0.063). Disease duration and forefoot bursae presence were significant prognostic indicators of foot impairment (p=0.009, p=0.012 respectively), explaining 16% of score variability in the final regression model. Disease duration, forefoot bursae and erosion presence were identified as significant prognostic indicators of activity limitation (p=0.006, p=0.019, p=0.002 respectively), explaining 35% of score variability in the final regression model.
Conclusion:
Despite advances in disease management, patients report disability associated with foot problems. Forefoot bursae should be considered for targeted therapy

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e-pub ahead of print date: 15 March 2012
Published date: August 2012
Keywords: arthritis, rheumatoid, foot, impairment, activity limitation, disability, bursa
Organisations: Faculty of Medicine, Faculty of Health Sciences

Identifiers

Local EPrints ID: 338332
URI: http://eprints.soton.ac.uk/id/eprint/338332
ISSN: 0004-3591
PURE UUID: f5669c15-49db-425b-9b80-65ed584cc9cc
ORCID for L. Hooper: ORCID iD orcid.org/0000-0002-3165-1004
ORCID for C.J. Bowen: ORCID iD orcid.org/0000-0002-7252-9515
ORCID for L. Gates: ORCID iD orcid.org/0000-0002-8627-3418
ORCID for D.J. Culliford: ORCID iD orcid.org/0000-0003-1663-0253

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Date deposited: 14 May 2012 12:55
Last modified: 17 Dec 2019 01:51

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