Rheumatologists need to pay more attention to the foot complaints of their rheumatoid arthritis patients, researchers said here at the European Union League Against Rheumatology (EULAR) 2008 Congress.
Dr. Simon Otter, Podiatry Course Leader at the University of Brighton (UK) and colleagues made this recommendation based on the results of their study showing that foot problems such as such as pain, stiffness, swelling, and numbness can severely undercut quality of life in rheumatoid arthritis patients.
"While foot complaints are common in rheumatoid arthritis patients, studies that have included the feet have reported the findings of clinical examination, such as the prevalence of deformities or radiological assessments, and have excluded quality of life measures," he explained.
"In addition, much of the literature on foot problems is quite old and is before the era of modern-day biologic therapy," he added. "Finally, it has usually been derived from the perspective of the clinician, while our study is reported from the perspective of the patient."
Dr. Otter and colleagues analyzed responses to a 33-item questionnaire completed by 190 rheumatoid arthritis patients attending outpatient clinics at three teaching hospitals in southeast England over a recent 4-week period.
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Overall, 177 (93.2%) reported that "their quality of life was adversely affected by their foot complaint(s), with over half describing their quality of life as being badly or very badly affected."
Patients were also asked to rate how severely foot complaints affect their quality of life using a 10-cm visual analogue scale. The mean score was 5.36. "This suggests that rheumatoid arthritis patients perceive that their foot complaints have a moderate to severe effect on their quality of life," Dr. Otter noted.
Nearly 80% of survey participants said that their foot complaints interfered with their ability to walk, and nearly 70% said it interfered with their ability to wear different shoes. Standing and changing shoes were also frequently described as difficult.
Participants, in turn, said that their specific foot complaints translate into limited mobility and a loss of independence and overall well-being.
"Part of the problem with clinicians is that they typically use outcome measures like the Disease Activity Score (DAS) 28 that includes hands, wrists, and knees but does not include the feet," Dr. Otter pointed out. "I think patients get a little frustrated when they perceive that their feet are ignored."
To improve the problem, he called for a closer link between rheumatologists and podiatrists akin to the link between diabetologists and podiatrists. "Diabetic patients -- at least in the UK -- see a podiatrist usually at the time of diagnosis, and often they are regularly screened from then on," he said. "That doesn't tend to happen with rheumatologists, and maybe it's a model that we should look at that might prove helpful."
At the very least, rheumatologists should examine the ankle and metatarsal phalangeal joints in their rheumatoid arthritis patients. "These are the joints that are most problematic in rheumatoid arthritis patients," he added.
None of my doctors pay attention to my foot complaints. Both ankles are very swollen (all the time), I have severe peripheral neuropathy in both feet which means numbess (like your foot being asleep) but at the same time, heightened sensitivity and constant burning. I've told all my doctors and none of them seem to care.