Foot ulceration affects a significant proportion of patients with rheumatoid arthritis (RA), say researchers who are calling for further investigation into the risk factors underlying this association.
"Foot problems are a major concern for people with RA, with the prevalence of foot involvement ranging from 16% at presentation to 90% over the course of the disease," explain Jill Firth (University of Leeds, UK) and co-authors.
"Although foot ulceration is perceived to be a common problem in patients with RA, little research has been undertaken in this area in the past," say the authors. They add that "the drive to reduce infection risk in immunosuppressed patients, particularly those receiving biologic therapy, and the trend towards earlier surgical intervention may be a precursor to change in incidence rates."
Firth and colleagues performed a postal survey of 1130 patients with RA in the UK receiving care from a rheumatologist.
Among the 78% of individuals who responded to the survey, the point prevalence of foot ulceration was 3.39% and the overall prevalence was 9.73%. The most commonly affected areas were the dorsal aspect of hammer toes, the metatarsal heads, and the metatarsophalangeal joint in patients with bunions. For just over a third of patients, ulceration was present at multiple sites. Among the reported cases, 10.76% were deemed to be false-positive and 11.76% were estimated to be false-negative.
Of note, duration of RA and the need for special footwear or surgery was significantly greater in those with open-foot and healed-foot ulceration than in patients with other types of ulceration.
"In conclusion, this study provides evidence that foot ulceration is not an uncommon problem for patients with RA, particularly those with longstanding disease," the researchers write in the journal Arthritis and Rheumatism.
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