Abstract
The vascular and cutaneous alterations evident in systemic sclerosis/scleroderma (SSc) place the foot at risk of ulceration. The UK Podiatry Rheumatic Care Association (PRCA)/Arthritis and Musculoskeletal Alliance standards of care recommend that all people with SSc should receive at least basic information about their foot health, and that those with foot problems should have access to self-management advice and care where needed. The aim of this study was to evaluate foot health services offered in Leeds (UK) for people with SSc, against nationally agreed standards of care. Ninety-one consecutive patients with SSc were selected from either the connective tissue disease outpatient clinic (n = 70) or the specialist rheumatology foot health clinic (n = 21) at Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust. All the patients completed a disease-specific audit tool developed by the UK PRCA that evaluates provision of foot health care for patients with SSc. Sixty-one patients (67%) reported having had foot problems at some point in time and 54 (59%) had current foot problems. Of these 54 patients, 17 (32%) had not received any foot care. Only 36 (39%) of the 91 patients had received any foot health information. This audit demonstrates that patients with SSc have a relatively high prevalence of self-reported foot problems. Foot health care and information are inadequate for people with SSc and foot problems, and preventative information is almost non-existent. Improved foot health information will better empower patients to self-manage low risk problems, and help identify high risk problems which require specialist care.
References
Della Rossa A, Valentini G (2001) European multicentre study to define disease activity criteria for systemic sclerosis. Clinical and epidemiological features of 290 patients for 19 centres. Ann Rheum Dis 60:585–591
Balbir-Gurman A, Denton CP, Nichols B, Knight CJ, Nahir AM, Martin G, Black CM (2002) Non-invasive measurement of biomechanical skin properties in systemic sclerosis. Ann Rheum Dis 61:237–241
Abraham D, Varga J (2005) Scleroderma: from cell and molecular mechanisms to disease models. Trends Immunol 26(11):587–595
Allcock RJ, Forrest I, Corris PA, Crook PR, Griffiths ID (2004) A study of the prevalence of systemic sclerosis in northeast England. Rheumatology 43:596–602
Mayes M (2003) Scleroderma epidemiology. Rheum Dis Clin North Am 29(2):239–254
Robert-Thompson PJ, Walker JG, Lu TY, Esterman T, Hakendorf AP, Smith MD, Ahern MJ (2006) Scleroderma in South Australia: further epidemiological observations supporting a stochastic explanation. Intern Med J 36:489–497
Wilson L (1997) Cost-of-illness of scleroderma: the case for rare diseases. Semin Arthritis Rheum 27(2):73–84
Sari-Kouzel H, Hutchinson CE, Middleton A, Webb F, Moore T, Griffin K, Herrick AL (2001) Foot problems in patients with systemic sclerosis. Rheumatology (Oxford) 40:410–413
La Montagna G, Baruffo A, Tirri R, Buono G, Valentini G (2002) Foot involvement in systemic sclerosis: a longitudinal study of 100 patients. Semin Arthritis Rheum 31:248–255
Hafner J, Schneider E, Burg G, Cassina P (2000) Management of leg ulcers in patients with rheumatoid arthritis or systemic sclerosis. J Vasc Surg 32:322–329
Matucci-Cerinic M, Seinold JR (2008) Digital ulcers and outcomes assessment in scleroderma. Rheumatology 47:v46–v47
Guiducci S, Giacomelli R, Cerinic MM (2007) Vascular complications of scleroderma. Autoimmun Rev 6:520–523
Amanzi L, Braschi F, Fiori G, Galluccio F, Miniati I, Guiducci S, Conforti ML, Kaloudi O, Nacci F, Sacu O, Candelieri A, Pignone A, Rasero L, Conforti D, Matucci-Cerinic M (2010) Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation of 1614 digital lesions. Rheumatology (Oxford) 49:1374–1382
Ho M, Veale D, Eastmond C, Nuki G, Belch J (2000) Macrovascular disease and systemic sclerosis. Ann Rheum Dis 59:39–43
UK PRCA/ARMA. http://www.prcassoc.org.uk/standards-project. Accessed 21 Jan 2011
UK/PRCA. http://www.prcassoc.org.uk/audit-tools. Accessed 21 Jan 2011
Menz HB, Gill TK, Taylor AW, Hill CL (2008) Predictors of podiatry utilisation in Australia: the North West Adelaide Health Study. J Foot Ankle Res 1(1):8
Garrow A, Silman A, Macfarlane G (2004) The Cheshire foot pain and disability survey: a population survey assessing prevalence and associations. Pain 110:378–384
Acknowledgements and funding
The authors would like to thank Dr Laszlo Szabo for his contribution to the patient recruitment. This work was supported by a portfolio of research funded by Arthritis Research UK and the National Institute of Health Research.
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Alcacer-Pitarch, B., Siddle, H.J., Buch, M.H. et al. Foot health needs in people with systemic sclerosis: an audit of foot health care provision. Clin Rheumatol 30, 1611–1615 (2011). https://doi.org/10.1007/s10067-011-1784-4
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DOI: https://doi.org/10.1007/s10067-011-1784-4