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The online version of this article (https://doi.org/10.1186/s13047-017-0229-y) contains supplementary material, which is available to authorized users.
Foot symptoms in rheumatoid arthritis (RA) derive from a combination of inflammation, altered foot mechanics, deformity and secondary skin lesions. Guidelines recommend regular review of patients’ feet, but the extent to which the general population of RA patients report foot symptoms and access foot care has not been established. The aims of this study were to determine the prevalence, impact and care of foot problems in all patients with RA in one geographical area and identify factors associated with accessing foot care.
Cross-sectional survey of a random sample of patients with RA, who resided within a single community-based National Health Service (NHS) podiatry service. The questionnaire collected demographic data (age, gender, local deprivation score), clinical data (disease duration, arthritis medications, disability (Health Assessment Questionnaire (HAQ)), current foot problems, foot care accessed (podiatry, orthotics and/or orthopaedics) and care received, measures of impact (Foot Impact Scale) and ability to work.
Of 1003 total eligible patients in the target population, 739 were posted survey packs. Of these 413 (56%) replied. Responders and non-responders had similar age (63.5 yr. vs.61.5 yr), gender (74.1%F vs. 75.2%F), and highest deprivation category (13.3% vs.15.9%). Of the responders 92.1% reported current foot problems: articular 73.8%, cutaneous lesions 65.4%, structural 57.6%, extra-articular 42.6%. Responders’ median (IQR) disease duration 10 (5–20) years, HAQ 1.5 (0.75–2.0), FISIF 10 (6–14) and FISAP 16 (7–23) and 37.8% reported impacts on work. While 69.5% had accessed foot care there were differences in the route of access (by gender and whether independent or NHS provision) and were older (64.9 yr. vs 60.4 yr. p = 0.001), had longer disease duration (12 yr. vs 7 yr. p < 0.001) and had a greater proportion of females (72.2% vs 61.7% p = 0.04) than those who had not accessed care.
Current foot problems were reported by 92.1% of the study sample and substantially impacted on life and work. While overall access to foot care was higher than anticipated, routes of access differed and extent of current problems suggests the provision of effective, timely and targeted care is a pressing need.
Additional file 1: Characteristics AFC versus NAFC. (DOCX 13 kb)13047_2017_229_MOESM1_ESM.docx
Erickson AR, Cannella AC, Mikuls TR. Clinical Features of Rheumatoid Arthritis. In: Firestein G, Budd R, Gabriel S, McInnes I, editors. Kelley and Firestein's textbook of rheumatology. Philadelphia: Elsevier; 2016. p. 1176–86.
Michelson J, Easley M, Wigley FM, Hellmann D. Foot and ankle problems in rheumatoid arthritis. Foot and Ankle Int. 1994;15(11):608–13. CrossRef
Hooper L, Bowen C, Gates L, et al. Prognostic indicators of foot related disability in patients with rheumatoid arthritis: results of a prospective three year study. Arthritis Care Res. 2012;64(8):1116–24.
Firth J, Hale C, Helliwell P, Hill J, Nelson E. The prevalence of foot ulceration in patients with rheumatoid arthritis. Arthritis Care Res. 2008;59(2):200–5. CrossRef
Wickman A, Pinzur M, Kadanoff R, Juknelis D. Health-related quality of life for patients with rheumatoid arthritis foot involvement. Foot and Ankle Inter. 2004;25(1):19–26. CrossRef
Brenton-Rule A, Dalbeth N, Menz HB, Bassett S, Rome K. Are foot and ankle characteristics associated with falls in people with rheumatoid arthritis? A prospective study. Arthritis Care Res. 2016;doi: https://doi.org/10.1002/acr.2313.
Wechalekar MD, Lester S, Hill CL, et al. Active foot synovitis in patients with rheumatoid arthritis: unstable remission status, radiographic progression, and worse functional outcomes in patients with foot synovitis in apparent remission. Arthritis Care Res. 2016;68(11):1616–23. CrossRef
Luqmani R, Hennell S, Estrach C, et al. British Society for Rheumatology and British health professionals in rheumatology standards guidelines and audit group (2006) British Society for Rheumatology and British health professionals in rheumatology guideline for the management of rheumatoid arthritis (the first two years). Rheumatology (Oxford). 2006;45(9):167–1169. CrossRef
Ndosi M, Ferguson R, Backhouse MR et al. National variation in the composition of rheumatology multidisciplinary teams: a cross-sectional study. Rheumatol Int. 2017;doi: https://doi.org/10.1007/s00296-017-3751-0.
Redmond A, Waxman R, Helliwell P. Provision of foot health services in rheumatology in the UK. Rheumatology (Oxford). 2006;45(5):571–6. CrossRef
Backhouse MR, Keenan AM, Hensor E, et al. Use of conservative and surgical foot care in an inception cohort of patients with rheumatoid arthritis. Rheumatology (Oxford). 2011;50(9):1586–95. CrossRef
Bristol Research Network. The population of Bristol 2012. Available from: https://bristolresearchnetwork.wordpress.com/2012/04/19/the-population-of-bristol-april-2012. Accessed 5 June 2017.
Kirwan J, Averns H, Creamer P, et al. Changes in rheumatology out-patient workload over 12 years in the south west of England. Rheumatology (Oxford). 2003;42(1):175–9. CrossRef
Van Belle G. Sastotical rules of thumb (2 nd Ed). New Jersey: John Wiley and Sons. 2008.
Wilson O. The impact frequency and care of foot problems in people with rheumatoid arthritis . PhD thesis, University of the West of England 2016. Available from: http://eprints.uwe.ac.uk/28929.
Helliwell P, Reay N, Gilworth G, et al. Development of a foot impact scale for rheumatoid arthritis. Arthritis Care Res. 2005;53(3):418–22. CrossRef
Kirwan J, Reeback J. Stanford health assessment questionnaire modified to assess disability in British patients with rheumatoid arthritis. Rheumatology (Oxford). 1986;25(2):206–9. CrossRef
Pallant J. SPSS survival manual: a step by step guide to data Analaysis using SPSS (4 th Ed). Berkshire: Open University Press; 2010.
Neame R, Hammond A. Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis. Rheumatology (Oxford). 2005;44(6):762–7. CrossRef
Goodacre L, Smith J, Meddis D, Goodacre J. Development and validation of a patient-centred measure of activity limitation (MAL) in rheumatoid arthritis. Rheumatology (Oxford). 2006;46(4):703–8. CrossRef
Sanderson T, Morris M, Calnan M, Richards P, Hewlett S. Patient perspective of measuring treatment efficacy: the rheumatoid arthritis patient priorities for pharmacologic interventions outcomes. Arthritis Care Res. 2010;62(5):647–56. CrossRef
Turner DE, Helliwell PS, Siegel KL, Woodburn J. Biomechanics of the foot in rheumatoid arthritis: identifying abnormal function and the factors associated with localised disease ‘impact’. Clinic Biomech (Bristol Avon). 2008;23(1):93–100. CrossRef
Barrett E, Scott D, Wiles NJ, Symmons D. The impact of rheumatoid arthritis on employment status in the early years of disease: a UK community-based study. Rheumatology (Oxford). 2000;39(12):1403–9. CrossRef
Verstappen SM, Bijlsma JW, Verkleij H, et al. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys. Arthritis Care Res. 2004;51(3):488–97. CrossRef
Olofsson T, Petersson I, Eriksson J, et al. Predictors of work disability during the first 3 years after diagnosis in a national rheumatoid arthritis inception cohort. Ann Rheum Dis. 2014;73:846–53. CrossRef
van der Heijde DM, van't Hof M, van Riel P, Van de Putte LB. Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol. 1993;20(3):579–81. PubMed
Jacobi CE, Triemstra M, Ripp I, Dinant HJ. Health care utilisation among rheumatoid arthritis patients referred to a rheumatology centre: unequal needs, unequal care? Arthritis Care Res. 2001;45(5):324–30. CrossRef
Andersen R. Revisiting the behavioural model and access to medical care: does it matter? J Helath Social Behav. 1995:1–10.
Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. Fam Prac. 2000;49:147–52.
Williams A, Graham G, Davies S, Bowen CJ. Guidelines for the management of people with foot health problems related to rheumatoid arthritis: a survey of their use in podiatry practice. J Foot Ankle Res. 2013;69(1):23. CrossRef
Helliwell PS. Lessons to be learned: review of a multidisciplinary foot clinic in rheumatology. Rheumatology (Oxford). 2003;42(11):1426–7. CrossRef
- Prevalence, impact and care of foot problems in people with rheumatoid arthritis: results from a United Kingdom based cross-sectional survey
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