Foot deformities in patients with rheumatoid arthritis: the relationship with foot functions

Aim: The aim of this study was to investigate foot deformities in patients with rheumatoid arthritis (RA), to detect frequency of deformities and to assess the relationship between foot deformities and foot functions. Methods: Anteroposterior and lateral radiographs of 40 patients and 40 control subjects were studied. The hallux valgus (HV) angle, intermetatarsal angle between first and second metatarsals, intermetatarsal angle between first and fifth metatarsals, and calcaneal pitch were measured on radiographs. Foot functions were measured by the Foot and Ankle Outcome Score (FAOS). Results: The frequency of foot deformities in RA patients was determined as 78.8%. The most frequent foot deformity in RA patients was HV (62.5%), followed by metatarsus primus varus (MPV) (41.3%). MPV and splaying of the forefoot deformities were significantly more frequent in RA patients than the control group (P < 0.05). Mild to moderate effect on FAOS subscales was observed in RA patients. There was a slight, but significant correlation between the foot deformities and the FAOS subscales except for quality of life subscale. Conclusions: In this study, it has been shown that foot deformities are frequent in patients with RA and that there is slight deterioration in foot functions related to RA. Our results indicated that foot deformities have small, but clinically important changes on foot functions. There is a need for more studies, which evaluates the foot deformities, to further explore the relationship between the foot deformities and foot function in patients with RA.     

A descriptive study of foot problems in children with juvenile rheumatoid arthritis (JRA)

In this study, we evaluated the feet of 144 consecutive children with juvenile rheumatoid arthritis (JRA) during a routine outpatient visit to discover patterns of foot problems. We found that all but nine subjects had at least 1 of 21 foot problems, categorized as inflammation, limitation of motion, and abnormal alignment. Overall, pronated rearfoot and midfoot were observed in 73% and 72% of JRA patients, respectively. Additionally, 36% had splayfoot, whereas 35% of subjects had ankle limitation of motion. Other common foot problems included pronated forefoot, rearfoot and forefoot synovitis, forefoot limitation of motion, and toe valgus. Significant differences in the occurrence of various foot problems were observed among JRA onset/course subgroups and were influenced by both age and disease duration. Specifically, subjects with polyarticular JRA had more forefoot limitation and toe valgus, whereas subjects with pauciarticular JRA had pronated forefoot more often. Ankle limitation of motion, although unrelated to the JRA subgroup, was related to the duration of JRA. Subjects with longer disease histories also had toe valgus more often. Conversely, forefoot limitation of motion seemed to be more a function of age than of disease duration. These results indicate that foot problems are common in the JRA population, and they underscore the need for thorough evaluation and physical therapy management.     

The predictors of foot ulceration in patients with rheumatoid arthritis: a preliminary investigation

We explored the predictors of foot ulceration in patients with rheumatoid arthritis (RA). The cases were 15 patients with RA reporting foot ulceration in response to a postal survey of patients sampled from a diagnostic register in secondary care (n = 1,130). The controls were 66 patients with RA randomly sampled from the survey respondents (n = 883) after matching for age, sex and disease duration. Patients with co-existent diabetes were excluded. Clinical examination included the assessment of known risk factors for foot ulceration in diabetes including: neuropathy (insensitivity to 10 g monofilament), peripheral vascular disease (ankle brachial pressure index [ABPI]), foot deformity (Platto indices) and raised plantar pressure (PressureStat™ readings). A 44 swollen-joint count, the presence of pre-ulcerative lesions and current steroid therapy were identified through univariate analysis as additional potential predictors in patients with RA. Forward step-wise logistic regression analysis showed that the following variables were significant predictors of ulceration: steroid therapy (OR = 9.70, 95%CI = 2.09–45.11, p = 0.004), abnormal ABPI (OR = 13.45, 95%CI = 1.19–151.43, p = 0.035), the presence of pre-ulcerative lesions (OR = 7.40, 95%CI = 1.51–36.30, p = 0.014) and swollen-joint count (OR = 1.25, 95%CI = 1.02–1.53, p = 0.034). Abnormal sensation, foot deformity and raised plantar pressures were not significant predictors of ulceration. The wide confidence intervals for ABPI were due to sparse data with very few abnormal values, and the results of exact logistic regression (more accurate where data is sparse and case matching employed) found that ABPI was no longer a significant predictor (p = 0.054). The significance of the other predictors did not differ substantially. In this preliminary study, abnormal sensation, foot deformity and raised plantar pressures were not significantly associated with foot ulceration but active disease and current steroid therapy were. The contribution of peripheral vascular disease to risk is unclear and further investigation is needed in a larger cohort.     

Foot deformities in rheumatoid arthritis and relevance of disease severity

OBJECTIVE: To investigate foot deformities in rheumatoid arthritis (RA) in relation to the disease severity. METHODS: Radiographs of 100 weight bearing feet of 50 patients who had had RA for >10 years (mean 13.5 years) were studied. The patients were classified into 2 study groups according to the severity of disease. We measured hallux valgus angle (HVA), intermetatarsal angle between first and 2nd (M1/2), and intermetatarsal angle between first and 5th (M1/5) on anteroposterior (AP) radiographs, as well as calcaneal pitch (CP) and first metatarsal pitch (MP) on lateral radiographs. The differences in these angles between the 2 groups (Inter-group study) and the correlations among angles within each group (Intra-group study) were examined. RESULTS: Inter-group study showed significant differences between the 2 groups for all variables. Intra-group study, on the other hand, showed no correlation between variables of the 2 deformities, i.e., splaying of forefoot (M1/2 and M1/5) and flattening of longitudinal arch (CP and MP). Only HVA correlated with the splaying (M1/2 and M1/5) in both study groups. CONCLUSION: Disease severity is related to the progression of foot deformities in RA, but the flattening and the splaying are not correlated with each other. We believe that foot deformities should be treated properly and early, especially for patients who are expected to have severe disease.     

Clinical relevance of antikeratin antibodies in rheumatoid arthritis

Summary Antikeratin antibodies (AKA) were found in 38 out of 96 patients with rheumatoid arthritis (RA); they appeared to be quite characteristic to this disease. There was a very low incidence of AKA positivity in the control groups, i.e., 1 out of 62 healthy subjects and 4 out of 158 other patients. With regard to the sensitivity of the test as a diagnostic tool, AKA was found to be weaker than the rheumatoid factor (RF) and the antiperinuclear factor (APF), whereas the specificity was much better than APF and RF. A clear correlation was shown between the titres of AKA and APF (p<0.001) and also between AKA levels and inflammation (p<0.02).     

Predictors of hand function in patients with rheumatoid arthritis

Objectives. The aims of this study were to determine: (1) what factors predict patient self-estimated hand function; (2) what factors predict actual hand function; and (3) the relationship among actual hand function, patient estimates of hand function, and self-assessed activities of daily living (ADL). Methods. Fifty-two patients with rheumatoid arthritis completed wrist and hand mobility measures, grip strength, pain, stiffness, and estimated hand function tests, along with the Sollerman Grip Function Test (actual hand function), Health Assessment Questionnaire (HAQ), and subscales of the Arthritis Impact Measurement Scales (AIMS). Results. Grip strength and stiffness were the strongest predictors of self-estimated hand function. Flexion and extension deficits in digits II through V were the strongest predictors of actual hand function. Actual hand function and self-estimated hand function were significantly correlated with each other and with the HAQ and AIMS subscales. Conclusions. Measures of deficit are the most useful in predicting actual hand function, whereas measures of strength and flexibility are most useful for estimated hand function.     

An 8-year follow-up study of pulmonary function in patients with rheumatoid arthritis

To evaluate longitudinal alterations in pulmonary function, 63 patients suffering from rheumatoid arthritis (RA) with previously reported reduced pulmonary diffusing capacity were re-examined in an 8-year follow-up study. Cross-sectional examination revealed normal values for vital capacity (VC), forced expiratory volume in 1 s (FEV1) and diffusing capacity per litre alveolar volume (KCO). Total diffusing capacity (D_LCO; P>0.0001), maximal expiratory flow at 75% of expired VC (MEF 75; P>0.0001) and MEF 50 (P>0.01) were decreased. Longitudinal evaluation revealed unchanged MEF50, MEF75 and FEV1, whereas increases in D_LCO (P>0.0001) and KCO (P>0.0001) and a decrease in VC (P>0.05) were found. The longitudinal changes in diffusing capacity were unrelated to patient age, disease duration, disease activity in the study period or pulmonary function at the first examination. Thus, in patients suffering from RA, the most prominent functional pulmonary abnormality, decreased diffusing capacity, appeared to improve in the course of time, despite a slight decrease in VC and continued articular disease activity.     

Anti-CCP antibodies in rheumatoid arthritis and psoriatic arthritis

Our aim is to assess the prevalence and associated clinical features of anti-CCP (cyclic citrullinated peptide) antibodies for RF (rheumatoid factor)-positive and RF-negative rheumatoid arthritis (RA) and psoriatic arthritis (PsA). In a prospective, cross-sectional, multi-centre study, we determined the titres of anti-CCP antibodies in 208 RA patients (129 RF-positive, 79 RF-negative), 56 PsA patients and 39 healthy controls (HC). Clinical parameters including disease activity (disease activity score 28-DAS28), physical disability (health assessment questionnaire-HAQ), functional capacity (functional class) and radiological erosions were investigated in patients with RA. In PsA patients, clinical and radiological features were determined. Anti-CCP2 antibodies were measured using a second-generation anti-CCP enzyme-linked immunosorbent assay (Euro-Diagnostica, Netherlands). One-hundred four of 129 RF-positive RA (81%), 16 of 79 RF-negative RA (20%), seven of 56 PsA patients (12.5%) and none of the HC had anti-CCP antibodies. RA patients with anti-CCP antibodies had significantly higher disease activity, greater loss of function and more frequent erosive disease than anti-CCP antibody-negative group. In subgroup analysis, anti-CCP antibodies in RF-negative patients were also associated with erosive disease. All PsA patients with anti-CCP antibodies had symmetric arthritis with higher number of swollen joints. The prevalence of anti-CCP antibodies in RF-positive RA patients was significantly higher than in RF-negative RA and PsA patients. Anti-CCP antibodies were also associated with erosive disease in RF-negative RA patients. Both anti-CCP and RF tests were negative in 30% of the patients. Anti-CCP positivity was a frequent finding in PsA and associated with symmetrical polyarthritis.     

Radiographic damage associated with low bone mineral density and vertebral deformities in rheumatoid arthritis: The Oslo‐Truro‐Amsterdam (OSTRA) collaborative study

Objective

To examine variables associated with bone mineral density (BMD) and vertebral deformities in women with rheumatoid arthritis (RA) from 3 northwest European countries.

Methods

Female patients were recruited from rheumatology clinics in Oslo, Norway; Truro, UK; and Amsterdam, The Netherlands (150 total, 50 per center, age 50–70 years, disease duration ≥5 years). Demographic and clinical data were collected and BMD was measured by means of dual energy x‐ray absorptiometry. Associations between demographic and clinical measures on the one hand and BMD and vertebral deformities on the other were investigated by single and multiple regression analyses.

Results

Body mass index (BMI), medication use, RA damage measures, and BMD differed significantly between the 3 centers. Overall, Norwegian patients had the lowest BMI, used more corticosteroids and antiosteoporotic drugs, had lower joint damage measured by Larsen score, and lower BMD at both spine and hip. High age, low BMI, and high cumulative dose of corticosteroids (last 2 years) are related to low BMD. A high Larsen score was associated with low BMD at the hip. Larsen score was the independent determinant of vertebral deformities after correction for center, age, BMI, and BMD.

Conclusion

Data from 3 countries on BMD and vertebral deformities in female patients aged 50–70 years with longstanding RA are presented, demonstrating an association between radiographic RA damage and low BMD and between radiographic RA damage and vertebral deformities.

     

Validity and responsiveness of a self-administered foot evaluation questionnaire in rheumatoid arthritis

Abstract

Objectives. A self-administered foot evaluation questionnaire (SAFE-Q) was developed by the Japanese Society for Surgery of the Foot (JSSF). The aim of this study is to evaluate the validity and responsiveness of the SAFE-Q in patients with rheumatoid arthritis (RA).

Methods. In total, 180 patients with RA answered the SAFE-Q. Of 180 patients, 34 answered the SAFE-Q twice, preoperatively and postoperatively, to assess responsiveness. Construct validity was tested by comparing the 5 SAFE-Q subscales and the JSSF standard rating system for the RA foot and ankle scale (JSSF-RA), a Japanese version of the Health Assessment Questionnaire (JHAQ), disease activity score in 28 joints (DAS28), simplified disease activity index (SDAI), and clinical disease activity index (CDAI). Responsiveness was examined by calculating the standardized response mean (SRM) and effect size (ES) 3 months after surgery.

Results. There were moderate correlations between the SAFE-Q and the JSSF-RA and JHAQ. Conversely, a low correlation was observed between the SAFE-Q and DAS28, SDAI, and CDAI. The responsiveness was high, with an SRM of 0.9 and ES of 0.7 for pain subscales.

Conclusion. SAFE-Q is a useful tool for assessing the foot and ankle in RA patients.     

早期类风湿关节炎患者外周血管病变和内皮功能的超声研究

目的应用高分辨率超声对早期类风湿关节炎(RA)患者外周动脉形态学、血流动力学及血管内皮功能的改变进行观察。方法检测30例早期RA患者与30例健康对照者肱动脉、足背动脉的变化,并进行统计学分析。结果 (1)RA组肱动脉、足背动脉内中膜厚度(IMT)均处于正常范围,但与对照组相比,RA组足背动脉IMT[(0.40±0.06)mm]明显增厚(P<0.01);肱动脉、足背动脉的舒张早期反向血流峰值流速(PRV)[肱动脉(15.52±2.37)cm/s;足背动脉(16.15±3.24)cm/s]、舒张末期血流速度(EDV)[肱动脉(10.87±2.16)cm/s;足背动脉(11.46±3.17)cm/s]和搏动指数(PI)(肱动脉5.95±1.89;足背动脉7.08±2.27)较对照组均明显减低(均为P<0.05)。(2)RA组肱动脉扩张系数(DC)(13.59±4.25)、血流介导的内径扩张百分比值(FMD)(14.52%±4.91%)较对照组减低,僵硬度(SD)(164.37±58.79)较对照组增高(均为P<0.05),而足背动脉的DC(12.17±3.64)和FMD(12.45%±3.24%)较对照组明显减低,SD(189.28±57.83)较对照组显著增高(均为P<0.01)。(3)Bland-Altman分析法显示重复测量肱动脉、足背动脉内皮功能参数差值与均值呈一致性的变化趋势。结论早期RA患者肢体动脉内皮功能受损,顺应性减低,僵硬度增加,高分辨率超声检查对于诊断RA患者早期动脉粥样硬化具有重要价值。     

Pericarditis in rheumatoid arthritis

Summary The annual incidence of clinically manifest pericarditis was found to be 0.34% in 157 females and 0.44% in 77 males with rheumatoid arthritis, observed for a mean time of 5.7 years. The development of pericarditis was independent of disease duration, but was related to extensive joint involvement, subcutaneous nodules, and a high Waaler Rose titre. Concomitant pleural effusion was present in four of five patients. Pericarditis in rheumatoid arthritis may indicate a serious prognosis quo ad vitam. Four of the five patients died within eight years, but their age at death was relatively high (62–73 years).     

Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiographic study

Objective The aim of the present study was to evaluate cardiac involvement in patients with active rheumatoid arthritis (RA).Methods Forty patients with active RA participated. All were submitted to standard Doppler echocardiography and myocardial performance index (MPI) grading.Results There were left and right ventricular diastolic function abnormalities in RA patients. Left ventricular MPI was also significantly higher than in controls (P<0.05). A relationship was found between left ventricular early diastolic (E)/atrial (A) flow velocities (E/A ratio), isovolumic relaxation time (IRT), and disease duration (r=–0.47 and P=0.002, r=0.618 and P=0.000, respectively).Conclusion Diastolic function was impaired in both ventricles in patients with active RA. There was a direct relationship between some of the parameters of left ventricular diastolic function and disease duration as well. These findings suggest a subclinical myocardial involvement in RA patients.     

Relationship between high-resolution computed tomography findings and the Stoke index in patients with rheumatoid arthritis

The aim of this study was to evaluate the relationship between high-resolution computed tomography (HRCT) findings and the Stoke index (SI) in patients with rheumatoid arthritis (RA). Forty RA patients (31 women, 9 men) were evaluated. All patients fulfilled the criteria proposed by the American College of Rheumatology. Clinical evaluation, haematological data, chest radiography, pulmonary function tests (PFTs) and HRCT were obtained in all patients. The SI was used to assess disease activity. In 17 (42.5%) patients, there were no signs of pulmonary involvement on HRCT; 23 (57.5%) of 40 patients had abnormal HRCT findings. Of 23 patients with HRCT abnormalities, six (two male, four female) had respiratory symptoms, four (one male, three female) had abnormalities on chest radiography and five (all female) had abnormalities on PFTs. There was no relationship between pulmonary changes observed on HRCT, clinical and laboratory disease activity parameters, chest X-ray and PFTs. There was no difference in the mean SI between patients included in the HRCT (+) and those included in the HRCT (-) groups. No significant correlations between the HRCT and the SI were seen. The main findings of this study are that HRCT can give useful information on RA-associated lung changes and that there was no relationship between the SI and the HRCT findings of patients with RA.     

Corticosteroid prescribing in rheumatoid arthritis and psoriatic arthritis

Corticosteroid usage was assessed in rheumatoid arthritis (RA) and psoriatic arthritis (PA) patients in Italy. A multicentre, observational study was undertaken in 10 Italian rheumatological centres from 1990 to 1992 using a computerised clinical data bank. Nine hundred and seven RA patients and 180 PA patients were studied; 510 (56.2%) RA patients and 44 (24.4%) PA patients were using corticosteroids. The percentage of patients taking corticosteroids ranged from 20.5 to 85.4% for RA patients and from 0 to 55% for PA patients for the different centres. Methylprednisolone was the most prescribed corticosteroid, both in RA patients (63.2%) and in PA patients (65.9%). The average methylprednisolone daily dose was 5.7±3.6 mg in RA patients and 4.5±1.4 mg in PA patients. The data provide evidence that corticosteroids are taken in an unexpectedly high percentage of patients with RA and PA in Italy.     

Comparison of sexual function in men with spondyloarthritis and rheumatoid arthritis

Aim of the workTo evaluate sexual function in Tunisian men with spondyloarthritis (SpA) and rheumatoid arthritis (RA) compared to healthy controls. The association between erectile dysfunction (ED) and specific parameters of SpA and RA was also studied.Patients and methodsThe study included 37 SpA, 13 RA patients and 50 healthy age matched controls. Sexual function of patients and controls was evaluated by the International Index of Erectile Function-5. ED was considered if the score was <21. Pain during intercourse and sexual desire were also assessed.ResultsThe mean age of the SpA and RA patients and control were comparable (42.5 ± 11.4 years, 49.6 ± 12.8 years and 48.8 ± 13.9 years). The prevalence of ED in rheumatic disease patients (SpA and RA) was 80% versus 70% in controls. A significant difference was found in the severity of the ED between patients and control (p = 0.04) and between SpA and RA patients (p = 0.012). There was also a higher prevalence of pain during intercourse (p < 0.0001), lower intensity of sexual desire (p = 0.005) and more dissatisfaction in relation with the partner (p < 0.0001) in the RD patients. ED in SpA and RA patients was significantly associated with higher age (p = 0.001), marital status (p = 0.007), higher age of disease’s onset (p = 0.027), pain during intercourse (p = 0.05) and lower sexual desire (p < 0.0001). On regression analysis, only sexual desire was significantly associated with ED (p = 0.03).ConclusionThis work suggests that patients with SpA or RA have a more severe ED in comparison with healthy control. However, specific disease parameters were not linked to ED.     

Doppler echocardiographic evaluation of ventricular function in patients with rheumatoid arthritis

 Cardiac involvement in rheumatoid arthritis (RA) has been reported previously. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been reported before. Thus, the aim of this study was to evaluate ventricular function by measurement of myocardial performance index (MPI) and transmitral flow propagation velocity (TFPV). Thirty-two patients with long-standing RA and 32 control subjects (mean ages 52 ± 11 and 50 ± 10 years, respectively) participated in this study. Systolic function was assessed by subjective evaluation of wall motion for both ventricles and by fractional shortening for the left ventricle (LV). LV diastolic function was evaluated by standard pulsed-wave Doppler echocardiography, MPI and TFPV. Right ventricular (RV) function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure. Systolic function was normal in all subjects. Among the echocardiographic indices of LV diastolic function the peak E velocity, E velocity/A velocity ratio, isovolumetric relaxation time, MPI and TFPV in the RA group were significantly different from those of the controls (P < 0.05). However, we did not observe a significant difference in RV echocardiographic indices between the two groups. Our results show that there is LV diastolic dysfunction in patients with long-standing RA. The lack of a history of cardiotoxic antirheumatic drug use among our patients suggests that this abnormality is due to RA itself. Received: 11 March 2002 / Accepted: 2 October 2002     

The rheumatoid heel: Its relationship to other disorders in the rheumatoid foot

Summary Fourhundred and eight rheumatoid feet are studied. The percentage of talalgia is 3.7%; for inferior exostosis it is 29.6%, and 30.8% for posterior exostosis. Posterior demineralisation is present in 12%, whereas for bony erosion it is 8.1%. Plantar spurs are very closely associated to flattened feet (p<0.0001). Likewise a very noticeable statistical association is noted between postero-superior calcaneilis and tarsal arthritis (p<0.0001), and calcaneitis was more frequent among marked valgus (p<0.001). These results are compared with findings of other works. Therapeutic consequences are evoked.     

简易胰岛素抵抗指数对类风湿关节炎患者胰岛素抵抗的评估价值

目的:利用空腹甘油三酯及葡萄糖简易指数（TyG）评估类风湿关节炎（RA）患者中的胰岛素抵抗（IR）,并探讨RA患者IR的相关因素。方法:选取2019年1月至12月新疆维吾尔自治区人民医院风湿免疫科未使用激素的RA患者177例,根据病程长短分为极早期RA（病程<6月）共45例,早期RA（病程6个月至2年）共64例,非早期...