The investigation of bursae in the forefoot of patients with rheumatoid arthritis using musculosketal ultra sound imaging performed by a podiatrist
The investigation of bursae in the forefoot of patients with rheumatoid arthritis using musculosketal ultra sound imaging performed by a podiatrist
Patients with rheumatoid arthritis (RA) frequently present with pain under their feet. Forefoot bursae can give rise to such symptoms, but are rarely investigated. The aim of this thesis was to use musculoskeletal ultrasound (MSUS) performed by a podiatrist to evaluate the prevalence and natural history of bursae in the forefoot in RA patients.
Once reliability of technique was established, a longitudinal study design was used in which a sample of RA patients (N=149) and a comparator group (N=50) of healthy individuals were assessed at baseline. A Diasus MSUS system was used to image the forefeet of all participants to determine prevalence of bursae. 120 patients (98 female, 22 male) with RA (24 seronegative, 93 seropositive, 3 unknown) completed the study at twelve months: mean age 60.7 (SD 12.1) years and disease duration 12.99 (10.4) years.
Results confirmed a high prevalence of forefoot bursae (92.6% of patients; mean per individual =3.54, range 0-9) and that these were often missed by clinical examination. Findings that there could be an association between patient reported foot impact scales of impairment/footwear (LFISIF) and activity participation restriction/limitation (LFISAP) and presence of bursae (LFISIF ?=0.377, p=0.033; LFISAP ?=0.762, p=0.013) independent of
disease activity were unique. On examination of prospective data after one year, 25.8% of participants had increases in bursae and 23.3% decreases. There was a significant
correlation between changes in bursae with changes in LFISIF (PCC=0.216, p=0.018) and LFISAP (PCC=0.193, p=0.036) and a significant negative correlation with changes in duration of RA (PCC=-0.269, p=0.003).
The findings imply that MSUS detectable bursae in the forefeet are highly prevalent, clinically under-reported and change over time. The findings suggest that bursae within the foot in RA deserve increased clinical attention and that further work is required to confirm associations with patient reported foot impact outcome measures.
rheumatoid arthritis, musculoskeletal ultrasound imaging, forefoot bursae
Bowen, Catherine Jane
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
April 2009
Bowen, Catherine Jane
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
Arden, Nigel
23af958d-835c-4d79-be54-4bbe4c68077f
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Dewbury, Keith
8190bf19-f678-4167-bece-d0a514d084e3
Bowen, Catherine Jane
(2009)
The investigation of bursae in the forefoot of patients with rheumatoid arthritis using musculosketal ultra sound imaging performed by a podiatrist.
University of Southampton, School of Health Sciences, Doctoral Thesis, 318pp.
Record type:
Thesis
(Doctoral)
Abstract
Patients with rheumatoid arthritis (RA) frequently present with pain under their feet. Forefoot bursae can give rise to such symptoms, but are rarely investigated. The aim of this thesis was to use musculoskeletal ultrasound (MSUS) performed by a podiatrist to evaluate the prevalence and natural history of bursae in the forefoot in RA patients.
Once reliability of technique was established, a longitudinal study design was used in which a sample of RA patients (N=149) and a comparator group (N=50) of healthy individuals were assessed at baseline. A Diasus MSUS system was used to image the forefeet of all participants to determine prevalence of bursae. 120 patients (98 female, 22 male) with RA (24 seronegative, 93 seropositive, 3 unknown) completed the study at twelve months: mean age 60.7 (SD 12.1) years and disease duration 12.99 (10.4) years.
Results confirmed a high prevalence of forefoot bursae (92.6% of patients; mean per individual =3.54, range 0-9) and that these were often missed by clinical examination. Findings that there could be an association between patient reported foot impact scales of impairment/footwear (LFISIF) and activity participation restriction/limitation (LFISAP) and presence of bursae (LFISIF ?=0.377, p=0.033; LFISAP ?=0.762, p=0.013) independent of
disease activity were unique. On examination of prospective data after one year, 25.8% of participants had increases in bursae and 23.3% decreases. There was a significant
correlation between changes in bursae with changes in LFISIF (PCC=0.216, p=0.018) and LFISAP (PCC=0.193, p=0.036) and a significant negative correlation with changes in duration of RA (PCC=-0.269, p=0.003).
The findings imply that MSUS detectable bursae in the forefeet are highly prevalent, clinically under-reported and change over time. The findings suggest that bursae within the foot in RA deserve increased clinical attention and that further work is required to confirm associations with patient reported foot impact outcome measures.
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PhD_thesis_CJB.pdf
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Published date: April 2009
Keywords:
rheumatoid arthritis, musculoskeletal ultrasound imaging, forefoot bursae
Organisations:
University of Southampton
Identifiers
Local EPrints ID: 71896
URI: http://eprints.soton.ac.uk/id/eprint/71896
PURE UUID: a811efd5-bdce-4acd-9518-e13a7ec37b59
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Date deposited: 18 Jan 2010
Last modified: 14 Mar 2024 02:46
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Contributors
Thesis advisor:
Keith Dewbury
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