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Yano K, Ikari K, Shiraki E, Midorikawa M, Maeda M, Kubo K, Kuwahara Y, Okazaki K. Short-term efficacy and limitations of foot care in patients with rheumatoid arthritis. Mod Rheumatol 2024; 34:1149-1152. [PMID: 38430527 DOI: 10.1093/mr/roae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/13/2024] [Indexed: 03/04/2024]
Abstract
OBJECTIVES Foot and ankle impairments are major issues in patients with rheumatoid arthritis (RA). Foot deformities often lead to skin disorders, such as callosities, ingrown toenails, and interdigital tinea pedis. This study was aimed at investigating the efficacy and limitations of foot care by experts in patients with RA. METHODS Thirty-one patients with RA who began receiving foot care from nurses at our institution between September 2020 and February 2023 were included. Responses to a survey using the self-administered foot evaluation questionnaire (SAFE-Q) for patient-reported outcome measures were compared at baseline, the second visit (1.3 ± 0.5 months after baseline), and the third visit (3.6 ± 1.6 months after baseline). RESULTS Scores for 'Pain and pain-related' and 'General health and well-being' components of SAFE-Q markedly improved after foot care. On the other hand, there were no significant differences in the scores for 'Physical functioning and daily living', 'Social functioning', and 'Shoe-related' components during observation periods. CONCLUSIONS Foot care for rheumatoid feet is effective in providing pain relief and improving general health and well-being. However, physical and social functioning and footwear issues did not improve. Clinicians must understand the effects and limitations of foot care in patients with RA.
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Affiliation(s)
- Koichiro Yano
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Foot Clinic Omotesando, Tokyo, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | | | | | | | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Zhao P, Chen Z, Wen Y, Zhang H, Wen L, Pei Z. The causality between rheumatoid arthritis and postural deformities: bidirectional Mendelian randomization study and mediation analysis. Front Immunol 2024; 15:1453685. [PMID: 39421746 PMCID: PMC11484279 DOI: 10.3389/fimmu.2024.1453685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 09/17/2024] [Indexed: 10/19/2024] Open
Abstract
Background To better understand the preventive or therapeutic clinical interventions that may be supported by the association between rheumatoid arthritis (RA) and postural deformities including hallux valgus, flat foot, and scoliosis, this study was conducted using Mendelian randomization (MR) analysis. It aimed to investigate whether RA is causally associated with postural deformities in European populations. Methods Summary-level data on RA and postural deformities were obtained from the IEU OpenGWAS project and Finngen database, respectively. LDSC regression analysis was conducted to assess the genetic correlation between these diseases. The inverse variance weighting (IVW) method was employed as the primary approach for two-sample MR analyses to evaluate causality. Supplementary methods included MR-Egger, maximum likelihood, weighted median, and cML-MA. To test for potential horizontal pleiotropy, we performed the MR-Egger intercept test, cML-MA, and secondary analyses after excluding confounders. Additionally, mediation analyses were conducted using two-step MR. Results The IVW method revealed RA to be causally associated with hallux valgus (OR 1.132, 95% CI 1.087-1.178, P < 0.001) and flat foot (OR 1.197, 95% CI 1.110-1.291, P < 0.001). Among postural deformities, hallux valgus was causally associated with flat foot (OR 1.823, 95% CI 1.569-2.119, P < 0.001) and scoliosis (OR 1.150, 95% CI 1.027-1.287, P < 0.05). No significant horizontal pleiotropy was detected. Moreover, mediation analyses indicated that hallux valgus mediates the effect of RA on flat foot (mediation effect 0.024, 95% CI 0.005-0.044, P < 0.05), with a mediation proportion of 41.31%. Conclusion These findings indicate a potential causal association between genetically predicted RA and both hallux valgus and flat foot. Furthermore, hallux valgus serves as a mediator in the pathway from RA to flat foot. This underscores the importance of early screening and preventive treatment of foot deformities in RA patients. Further research is necessary to determine the applicability of these findings in non-European populations.
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Affiliation(s)
- Piqian Zhao
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Beijing, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Zhe Chen
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Ya Wen
- Capital Medical University School of Biomedical Engineering, Beijing, China
| | - Hongtao Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Liangyuan Wen
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Beijing, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zijie Pei
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Beijing, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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3
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Gamez-Guijarro M, Reinoso-Cobo A, Perez-Galan MJ, Ortega-Avila AB, Ramos-Petersen L, Torrontegui-Duarte M, Gijon-Nogueron G, Lopezosa-Reca E. Foot Anthropometry Measures in Relation to Treatment in Patients with Rheumatoid Arthritis: A Longitudinal Study. Healthcare (Basel) 2024; 12:1656. [PMID: 39201214 PMCID: PMC11353708 DOI: 10.3390/healthcare12161656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/13/2024] [Accepted: 08/18/2024] [Indexed: 09/02/2024] Open
Abstract
Approximately 90% of patients with arthritis exhibit forefoot deformities, including deformities within the metatarsophalangeal and proximal interphalangeal joints. Current pharmacological treatment with Disease Modifying Antirheumatic Drugs (DMARDs) consists of two groups: synthetic drugs (sDMARDs) and biological drugs (bDMARDs). The objective of our study was to investigate foot anthropometry changes in RA patients based on the administered treatment over a five-year period Method: A longitudinal analysis was conducted with RA patients who were grouped based on their pharmacological treatment. The pharmacological treatment groups were categorized into (I) methotrexate (MTX), (II) MTX plus biological treatments (including all variables), (III) biological treatment alone, and (IV) a miscellaneous group comprising patients with diverse treatments, including patients for whom various drugs had failed or who had not achieved remission with pharmacological treatment. For the anthropometric measurements, a foot measurement platform validated by McPoil et al. was used. Post hoc analyses with Bonferroni correction were performed to identify pairwise differences between the treatment groups while controlling for Type I errors due to multiple comparisons. Results: In the period from 2018 to 2023, significant changes were observed in several foot measurements. For instance, the MTX group showed a statistically significant increase in left heel width (p = 0.026). The MTX group experienced a slight increase in left foot length, while the Biologics and MTX + Bio groups exhibited more substantial increases in both maximum medial arch height and midfoot width. Conclusions: Different RA treatments can have a significant impact on foot structure over a five-year period, showing notable changes in heel width and overall foot morphology. Combined treatments with MTX and biologics potentially offer better management of RA.
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Affiliation(s)
- Maria Gamez-Guijarro
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.R.-C.); (A.B.O.-A.); (L.R.-P.); (M.T.-D.); (E.L.-R.)
| | - Andres Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.R.-C.); (A.B.O.-A.); (L.R.-P.); (M.T.-D.); (E.L.-R.)
| | - Maria Jose Perez-Galan
- Department of Rheumatology, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.R.-C.); (A.B.O.-A.); (L.R.-P.); (M.T.-D.); (E.L.-R.)
- IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.R.-C.); (A.B.O.-A.); (L.R.-P.); (M.T.-D.); (E.L.-R.)
| | - Marcelino Torrontegui-Duarte
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.R.-C.); (A.B.O.-A.); (L.R.-P.); (M.T.-D.); (E.L.-R.)
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.R.-C.); (A.B.O.-A.); (L.R.-P.); (M.T.-D.); (E.L.-R.)
- IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - Eva Lopezosa-Reca
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.R.-C.); (A.B.O.-A.); (L.R.-P.); (M.T.-D.); (E.L.-R.)
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4
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Gamez-Guijarro M, Reinoso-Cobo A, Gordillo-Fernandez LM, Ortiz-Romero M, Ortega-Avila AB, Chicharro-Luna E, Gijon-Nogueron G, Lopezosa-Reca E. Update of Modified Version of the Foot Function Index Tool Spanish Version (FFI-Sp), in Patients with Rheumatoid Arthritis: Cross Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1339. [PMID: 39202620 PMCID: PMC11356240 DOI: 10.3390/medicina60081339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/31/2024] [Accepted: 08/15/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: The Foot Function Index (FFI) is a widely recognized patient-reported outcome measure (PROM) for assessing foot functionality and its impact on quality of life in individuals with rheumatoid arthritis (RA). This study aimed to observe the behavior of the tool in the Spanish population with RA, optimize the tool, and check its functionality. Materials and Methods: A total of 549 RA patients, with a predominant female participation (75.6%). This study involved a comprehensive statistical analysis, leading to a refined version of the FFI for a Spanish-speaking population. Results: The original 23-item FFI was revised, resulting in a 15-item version by excluding items that caused confusion or were considered redundant. This modified version maintained the original's subscales of pain, disability, and activity limitation, but with an adjusted item distribution. The construct validity was confirmed through exploratory factor analysis, demonstrating excellent fit indices (Kaiser-Meyer-Olkin test = 0.926, Bartlett's test of sphericity = 4123.48, p < 0.001). The revised FFI demonstrated good internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (ICC = 0.89). Conclusions: This study highlights the applicability of the FFI in Spanish-speaking RA populations, offering a valid and reliable tool for clinicians and researchers. The modifications enhance the FFI's relevance for RA patients, facilitating better assessment and management of foot-related functional impairments.
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Affiliation(s)
- Maria Gamez-Guijarro
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.B.O.-A.); (G.G.-N.); (E.L.-R.)
| | - Andres Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.B.O.-A.); (G.G.-N.); (E.L.-R.)
| | | | - Mercedes Ortiz-Romero
- Department of Podiatry, Universidad de Sevilla, 41009 Sevilla, Spain; (L.M.G.-F.); (M.O.-R.)
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.B.O.-A.); (G.G.-N.); (E.L.-R.)
- IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - Esther Chicharro-Luna
- Department Behavioral Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, 03202 Alicante, Spain;
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.B.O.-A.); (G.G.-N.); (E.L.-R.)
- IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - Eva Lopezosa-Reca
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.G.-G.); (A.B.O.-A.); (G.G.-N.); (E.L.-R.)
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5
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Gassara Z, Feki A, Hakim Z, Ben Djmeaa S, Abid C, Kallel MH, Fourati H, Baklouti S. Foot involvement in psoriatic arthritis: Prevalence, clinical and radiological features. Foot Ankle Surg 2024; 30:465-470. [PMID: 38538387 DOI: 10.1016/j.fas.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/04/2024] [Accepted: 03/14/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND The purpose of this study was to evaluate the prevalence of foot involvement in psoriatic arthritis and to describe its different clinical and radiological features. PATIENTS AND METHODS We conducted a cross sectional study including 40 patients with psoriatic arthritis over a period of 12 months. Anamnesis, clinical examination of feet, podoscopic examination, X-rays of feet and heels, and ultrasound in B mode and power Doppler mode were done for each patient. RESULTS Foot involvement was found in 95% of cases. It was symptomatic in 70% and inaugural of the disease in 20% of cases. The hindfoot and the forefoot were the sites most affected (77.5% and 47.5% respectively). The involvement of the midfoot was rarer (25%). Dactylitis was found in 17.5% and deformities of forefoot were found in 22.5% of cases. Antalgic gait was noted in 17.5% and static disorders of foot at podoscopic examination were identified in 35% of cases. Feet dermatological manifestations were found in 45% of cases. Diagnosis of different rheumatological manifestations was based on clinical findings and caracteristic radiological images on X-rays. We demonstrate he sensitivity of ultrasound in the detection and the diagnosis of different foot lesions including enthesitis, synovitis and tenosynovitis, dactylitis, bone erosions and psoriatic nail dystrophy.
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Affiliation(s)
- Zouhour Gassara
- Rheumatology Department, Hedi Chaker Hospital, Sfax, Tunisia.
| | - Afef Feki
- Rheumatology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Zina Hakim
- Faculty of Medicine of Sfax, Sfax, Tunisia
| | | | - Cyrine Abid
- Rheumatology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | | | - Hela Fourati
- Rheumatology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Sofien Baklouti
- Rheumatology Department, Hedi Chaker Hospital, Sfax, Tunisia
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Ramos-Petersen L, Reinoso-Cobo A, Ortega-Avila AB, Garcia-Campos J, Bernal JA, Cantero-Tellez R, Martin-Martin JM, Caliz-Caliz R, Tejero S, Cano-Garcia L, Gijon-Nogueron G. A clinical practice guideline for the management of the foot and ankle in rheumatoid arthritis. Rheumatol Int 2024; 44:1381-1393. [PMID: 38850327 PMCID: PMC11222212 DOI: 10.1007/s00296-024-05633-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
Rheumatoid arthritis causes progressive joint destruction in the long term, causing a deterioration of the foot and ankle. A clinical practice guideline has been created with the main objective of providing recommendations in the field of podiatry for the conservative management of rheumatoid arthritis. Thus, healthcare professionals involved in foot care of adults with rheumatoid arthritis will be able to follow practical recommendations. A clinical practice guideline was created including a group of experts (podiatrists, rheumatologists, nurses, an orthopaedic surgeon, a physiotherapist, an occupational therapist and patient with rheumatoid arthritis). Methodological experts using GRADE were tasked with systematically reviewing the available scientific evidence and developing the information which serves as a basis for the expert group to make recommendations. Key findings include the efficacy of chiropody in alleviating hyperkeratotic lesions and improving short-term pain and functionality. Notably, custom and standardized foot orthoses demonstrated significant benefits in reducing foot pain, enhancing physical function, and improving life quality. Therapeutic footwear was identified as crucial for pain reduction and mobility improvement, emphasizing the necessity for custom-made options tailored to individual patient needs. Surgical interventions were recommended for cases which were non-responsive to conservative treatments, aimed at preserving foot functionality and reducing pain. Moreover, self-care strategies and education were underscored as essential components for promoting patient independence and health maintenance. A series of recommendations have been created which will help professionals and patients to manage podiatric pathologies derived from rheumatoid arthritis.
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Affiliation(s)
- Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, Malaga, 29071, Spain
| | - Andres Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, Malaga, 29071, Spain.
| | - Ana-Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, Malaga, 29071, Spain
- IBIMA, Malaga, Spain
| | - Jonatan Garcia-Campos
- Department of Behavioral and Health Sciences, Miguel Hernández University, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Jose-Antonio Bernal
- Department of Rheumatology, Hospital Marina Baixa, Villajoyosa(Alicante), Spain
| | - Raquel Cantero-Tellez
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, Malaga, 29071, Spain
| | - Jose-Maria Martin-Martin
- Hospital Universitario Nuestra Señora de la Candelaria de Tenerife, Santa Cruz de Tenerife, Spain
| | - Rafael Caliz-Caliz
- Rheumatology Department. Granada, Virgen de las Nieves Hospital, Granada, Spain
| | - Sergio Tejero
- Orthopaedic Department of University Hospital Virgen del Rocío. Head of Foot Ankle Unit, Department of Surgery, University of Sevilla, Seville, Spain
| | - Laura Cano-Garcia
- IBIMA, Malaga, Spain
- Regional University Hospital of Malaga, Málaga, Spain
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, Malaga, 29071, Spain
- IBIMA, Malaga, Spain
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Alkady EAM, El-Adly W, Mahran SA, Osman AE, Salem GI, Abdelwahed D, Abdelaziz MM. New Insight into the Effects of Different Types of Midfoot and Hindfoot Deformities on the Functional Outcomes of Rheumatoid Arthritis Patients. J Foot Ankle Surg 2024:S1067-2516(24)00148-0. [PMID: 38996960 DOI: 10.1053/j.jfas.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/23/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
In advanced stages of rheumatoid arthritis (RA), the pattern of joint involvement leads to varied types of foot deformities such as forefoot, midfoot, and hindfoot deformities. We aim to evaluate midfoot and hindfoot deformities and their effect on functional outcomes in RA patients. In this prospective cross-sectional study clinical and radiological evaluations of 100 adult RA patients were studied for midfoot and hindfoot deformities. The RA disease activity, functional disability level, specific foot and ankle assessments, gait speed, and balance tests were assessed. Radiological examinations of the weight-bearing feet in a standing position were done. We found that the most frequent deformity type was the planovalgus foot (24%). There were statistically significant differences between the types of foot deformities and disease duration, disease activity, falls, Tinetti and Berg balance Test, and health assessment questionnaire-disability index. The multivariate regression analysis of independent correlates of falling detected that patients with equinovarus deformity were 2.5 times more liable for falling with 63.5% predictive power. According to the predictive criteria of deformity type for falling, the equinocavovarus type had accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 84.5%, 98.5%, 99%, and 84%, respectively. We found in RA patients, midfoot and hindfoot deformities cause a significant reduction of functional ability and quality of life. The early detection of foot deformities requires a good awareness of the clinical and radiographic diagnosis of different types of deformities thus reducing the possible functional disabilities via early management by combined orthotic, physiotherapy, and surgical treatments.
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Affiliation(s)
- Eman A M Alkady
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Wael El-Adly
- Orthopedic Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Safaa A Mahran
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed E Osman
- Orthopedic Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Gehan Ibrahim Salem
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dalia Abdelwahed
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Marwa Mahmoud Abdelaziz
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Bueno Fermoso R, Morales Lozano MR, Nieto Cordero M, Martínez Rincón C, García-Fernández P, González Fernández ML. Differences and Similarities in the Feet of Metatarsalgia Patients with and without Rheumatoid Arthritis in Remission. J Clin Med 2024; 13:2881. [PMID: 38792423 PMCID: PMC11122280 DOI: 10.3390/jcm13102881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Objectives: Metatarsalgia continues to be a problem in patients with rheumatoid arthritis (RA) in remission (remRA), as well as in the non-rheumatic population, with a mechanical origin. Identify and compare clinical, morphological, disability, synovitis (ultrasound), and radiological osteoarticular damage characteristics in two groups of patients with lesser-ray metar-tarsalgia, with remRA, and without RA. Methods: Cross-sectional study with 84 patients with remRA (mRA) and 60 patients without RA (nmRA). The study evaluated five clinical variables (pain, Foot Function Index (FFI), joint mobility, digital deformities, and foot type), a radiological variable (osteoarticular damage), and an ultrasound variable (metatarsal synovitis). The data were analysed using descriptive and correlational techniques. Results: There were no significant differences in sex, age, body mass index (BMI), or degree of pain. Both groups showed a high prevalence of limited joint mobility for the ankle and first metatarsal phalanx (DF1st MTPJ) and digital deformities, with no statistically significant differences. Similarly, there were no differences in lesser-ray synovitis. On the other hand, there were differences in mRA with greater disability and activity limitation (FFI), LDD (lesser-ray digital deformities) stiffness, first-ray deformities, radiological damage, synovitis in 1st MTPJ, and positive Doppler (five patients). Conclusions: Metatarsalgia presents similarities in both populations. Biomechanical factors may influence the symptoms and presence of synovitis in patients with RA in remission. Other characteristics are more frequent in mRA, which could be related to the disease; thus, future research should include both biomechanical and ultrasound exploration of the foot in the valuation of patients in remission.
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Affiliation(s)
| | - Maria Rosario Morales Lozano
- Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (R.B.F.); (M.N.C.); (C.M.R.); (P.G.-F.); (M.L.G.F.)
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9
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Hall BE, Mazhar K, Macdonald E, Cassidy M, Doty M, Judkins C, Terse A, Shiers S, Tadros S, Yun S, Burton MD, Price TJ, Kulkarni A. Transcriptome Analysis of Rheumatoid Arthritis Uncovers Genes Linked to Inflammation-Induced Pain. RESEARCH SQUARE 2024:rs.3.rs-4218885. [PMID: 38712195 PMCID: PMC11071542 DOI: 10.21203/rs.3.rs-4218885/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Autoimmune diseases such as rheumatoid arthritis (RA) can promote states of chronic Inflammation with accompanying tissue destruction and pain. RA can cause inflammatory synovitis in peripheral joints, particularly within the hands and feet, but can also sometimes trigger temporomandibular joint (TMJ) arthralgia. To better understand the effects of ongoing Inflammation-induced pain signaling, dorsal root ganglia (DRGs) were acquired from individuals with RA for transcriptomic study. We conducted RNA sequencing from the L5 DRGs because it contains the soma of the sensory neurons that innervate the affected joints in the foot. DRGs from 5 RA patients were compared with 9 non-arthritic controls. RNA-seq of L5 DRGs identified 128 differentially expressed genes (DEGs) that were dysregulated in the RA subjects as compared to the non-arthritic controls. The DRG resides outside the blood brain barrier and, as such, our initial transcriptome analysis detected signs of an autoimmune disorder including the upregulated expression of immunoglobulins and other immunologically related genes within the DRGs of the RA donors. Additionally, we saw the upregulation in genes implicated in neurogenesis that could promote pain hypersensitivity. overall, our DRG analysis suggests that there are upregulated inflammatory and pain signaling pathways that can contribute to chronic pain in RA.
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Affiliation(s)
- Bradford E Hall
- National Institute of Dental and Craniofacial Research, National Institutes of Health
| | | | - Emma Macdonald
- National Institute of Dental and Craniofacial Research, National Institutes of Health
| | - Margaret Cassidy
- National Institute of Dental and Craniofacial Research, National Institutes of Health
| | - Megan Doty
- National Institute of Dental and Craniofacial Research, National Institutes of Health
| | - Christian Judkins
- National Institute of Dental and Craniofacial Research, National Institutes of Health
| | - Anita Terse
- National Institute of Dental and Craniofacial Research, National Institutes of Health
| | | | - Saber Tadros
- National Cancer Institute, National Institutes of Health
| | | | | | | | - Ashok Kulkarni
- National Institute of Dental and Craniofacial Research, National Institutes of Health
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10
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Kimura Y, Kikkawa I, Sugimoto H, Kawai S, Takeshita K. The onset of intermetatarsal bursitis in patient with rheumatoid arthritis - Case report of surgical treatment. Int J Surg Case Rep 2024; 117:109537. [PMID: 38503164 PMCID: PMC10963219 DOI: 10.1016/j.ijscr.2024.109537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Mono-arthritis and intermetatarsal bursitis according to rheumatoid arthritis aren't aware among general orthopedic surgeon. This report describes a case of surgical treatment of intermetatarsal bursitis. PRESENTATION OF CASE A 50-year-old female presented with three years of metatarsophalangeal joint pain and deformity. MRI showed bursitis and synovial proliferation around the joint. Synovectomy reduced pain and foot deformity. After surgery, the patient was administered methotrexate. DISCUSSION There were previous studies reporting intermetatarsal bursitis associated with rheumatoid arthritis, few case reports were found in which surgery and pathological examination were performed. CONCLUSION Intermetatarsal bursitis is common for patients with rheumatoid arthritis. Early diagnosis and early appropriate treatment is necessary.
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Affiliation(s)
- Yuya Kimura
- Department of Orthopedic Surgery, Nasu Chuoh Hospital, Otawara, Japan.
| | - Ichiro Kikkawa
- Department of Orthopedic Surgery, Nasu Chuoh Hospital, Otawara, Japan
| | - Hideharu Sugimoto
- Department of Radiology, Shin-Kaminokawa Hospital, Kaminokawa, Japan
| | - Shigeo Kawai
- Department of Pathology, Tochigi Medical Center Shimotsuga, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
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11
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Chen Y, Tian Y, Liu H, Li Q, Luo Z, Ran J, Miao Z, Zhang Q, Yin G, Xie Q. Repurposed drug agomelatine is therapeutic against collagen-induced arthritis via iNOS targeting. Int Immunopharmacol 2024; 130:111750. [PMID: 38442577 DOI: 10.1016/j.intimp.2024.111750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The most promising biologics tumor necrosis factor α (TNFα) inhibitors are effective in treating rheumatoid arthritis (RA) in only 50-70 % of the cases; thus, new drugs targeting TNFα-mediated inflammation are required. METHODS Firstly, the drugs that could inhibit FLS proliferation and TNFα induced inflammatory cytokine production were screened. Secondly, treatment effects of the identified drugs were screened in collagen-induced arthritis (CIA) mouse model. Thirdly, the inhibitory effect of the identified drug, agomelatine (AOM), on TNFα induced inflammatory cytokine production and NF-κB activity were confirmed. Fourthly, bioinformatics was applied to predict the binding target of AOM and the binding was confirmed, and the already known inhibitor of target was used to test the treatment effect for CIA mouse model. Finally, the effect of AOM on signaling pathway was tested and on TNFα induced inflammatory cytokine production was observed after inhibiting the target. RESULTS AOM effectively inhibited TNFα-induced NF-κB activation, NF-κB p65 translocation, and inflammatory cytokines production in vitro and was therapeutic against CIA. The mechanistic study indicated inducible nitric oxide synthase (iNOS) as the binding target of AOM. 1400 W, a known inhibitor of iNOS, could effectively treat CIA by decreasing iNOS activity and the levels of inflammatory cytokines. The inhibitory effect of AOM on TNFα-induced inflammation was further elucidated by 1400 W, or NF-κB p65 inhibitor JSH-23, indicating that AOM is therapeutic against CIA via iNOS/ERK/p65 signaling pathway after binding with iNOS. CONCLUSIONS AOM is therapeutic against CIA via inhibition of the iNOS/ERK/p65 signaling pathway after binding with iNOS.
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Affiliation(s)
- Yuehong Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yunru Tian
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Huan Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qianwei Li
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhongling Luo
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jingjing Ran
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhiyong Miao
- Laboratory of Human Diseases and Immunotherapies, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiuping Zhang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Geng Yin
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China.
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12
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Goyal AK, Mohanty SK. Socioeconomic variation in the prevalence of pain by anatomical sites among middle-aged and older adults in India: a cross-sectional study. BMC Geriatr 2024; 24:198. [PMID: 38413878 PMCID: PMC10900751 DOI: 10.1186/s12877-024-04780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Pain is a significant global public health concern, particularly among individuals aged 45 and above. Its impact on the overall lifestyle of the individuals varies depending on the affected anatomical parts. Despite its widespread impact, there is limited awareness of the attributes of pain, making effective pain management challenging, particularly in India. This study aims to estimate the prevalence and variation in pain in different anatomical sites among middle-aged and older adults in India. METHODS A cross-sectional design was employed, utilising data from the first wave of the Longitudinal Aging Study in India (LASI), 2017-2018. The age-sex adjusted prevalence of pain by anatomical sites (the back, joints, and ankles) was estimated using a multivariate logistic regression model. RESULTS 47% of individuals aged 45 years and above reported joint pain, 31% reported back pain and 20% suffered from ankle or foot pain. The prevalence of pain at all the anatomical sites increased with age and was reported higher among females. Relative to respondents aged 45-59 years, those aged 75 years and older exhibited a 41% higher likelihood of experiencing back pain (AOR: 1.41, 95% CI: 1.19-1.67), a 67% higher likelihood of joint pain (AOR: 1.67, 95% CI: 1.49-1.89), and a 32% higher likelihood of ankle/foot pain (AOR: 1.32, 95% CI: 1.16-1.50). In comparison to males, females had a 56% higher likelihood of encountering back pain (AOR: 1.56, 95% CI: 1.40-1.74), a 38% higher likelihood of joint pain (AOR: 1.38, 95% CI: 1.27-1.50), and a 35% higher likelihood of ankle/foot pain (AOR: 1.35, 95% CI: 1.17-1.57). We also found significant regional variations in pain prevalence, with higher rates in the mountainous regions of India. CONCLUSION This research highlights the high burden of pain in major anatomical sites among middle-aged and older adults in India and emphasises the need for increased awareness and effective pain management strategies.
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13
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Veiga-Seijo R, Pertega-Diaz S, Perez-Lopez ME, Martinez LC, Novoa SA, Gonzalez-Martin C. Foot health and quality of life in women with breast cancer undergoing chemotherapy: a cross-sectional study. J Foot Ankle Res 2023; 16:52. [PMID: 37599367 PMCID: PMC10440865 DOI: 10.1186/s13047-023-00650-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Chemotherapy is one of the most widely used therapies for breast cancer, triggering important repercussions on people's quality of life. However, little research has been undertaken about podiatric adverse effects. This study aimed was to determine the prevalence of podiatric pathology developed in people with breast cancer who receive chemotherapy. METHODS Observational, descriptive, and cross-sectional study was conducted in the Oncology service of the A Coruña University Hospital (northwest Spain). People with breast cancer and undergoing chemotherapy treatment of legal age (≥ 18), who signed the informed consent (n = 117) were included. Sociodemographic, comorbidity, disease and foot health variables, as well as two self-administered questionnaires (Foot Health Status Questionnaire and Foot Function Index) were studied. The current ethical-legal aspects were followed. RESULTS Foot health problems were highly prevalent, highlighting nail color changes (59.8%), onychocryptosis (39.7%), xerosis (62.4%), plantar fasciitis (12.8%), and neuropathic symptoms (75.2%). Some foot pain was presented in 77.8% of the sample, predominantly at nail level (15.4%) or sole of the foot and nail (14.5%). Most participants described their foot health as fair or poor (56.4%) and felt limited in walking (65.8%). The lowest score for the Foot Health Status Questionnaire was footwear (30.6(33.5)). CONCLUSIONS Foot health adverse effects represent worrisome problems in women with breast cancer undergoing chemotherapy, due to their high prevalence and negative implications on quality of life. These problems are critical as they may have implications for stopping or reducing chemotherapy. All these results call for the development of more research to contribute to the care and wellbeing of people with cancer who receive treatments such as chemotherapy. Thus, this line of research is a new path to be developed by the podiatry community.
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Affiliation(s)
- Raquel Veiga-Seijo
- Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Campus Esteiro, Ferrol, 15471, Spain.
- Research Group in Nursing and Health Care, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Sergas, Universidade da Coruña (UDC), A Coruña, 15006, Spain.
- Research Group in Rheumatology and Health (GIR-S), Faculty of Physiotherapy, Universidade da Coruña (UDC), Campus Oza, A Coruña, 15008, Spain.
| | - Sonia Pertega-Diaz
- Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Campus Esteiro, Ferrol, 15471, Spain
- Research Group in Nursing and Health Care, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Sergas, Universidade da Coruña (UDC), A Coruña, 15006, Spain
- Research Group in Rheumatology and Health (GIR-S), Faculty of Physiotherapy, Universidade da Coruña (UDC), Campus Oza, A Coruña, 15008, Spain
| | - Maria Eva Perez-Lopez
- Breast Unit, Medical Oncology Department, Hospital Universitario de A Coruña (HUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, A Coruña, 15006, Spain
| | - Lourdes Calvo Martinez
- Breast Unit, Medical Oncology Department, Hospital Universitario de A Coruña (HUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, A Coruña, 15006, Spain
| | - Silvia Antolin Novoa
- Breast Unit, Medical Oncology Department, Hospital Universitario de A Coruña (HUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, A Coruña, 15006, Spain
| | - Cristina Gonzalez-Martin
- Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Campus Esteiro, Ferrol, 15471, Spain
- Research Group in Nursing and Health Care, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Sergas, Universidade da Coruña (UDC), A Coruña, 15006, Spain
- Research Group in Rheumatology and Health (GIR-S), Faculty of Physiotherapy, Universidade da Coruña (UDC), Campus Oza, A Coruña, 15008, Spain
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14
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Stolt M, Laitinen AM, Kankaanpää K, Katajisto J, Cherry L. The prevalence of foot health problems in people living with a rheumatic condition: a cross-sectional observational epidemiological study. Rheumatol Int 2023; 43:283-291. [PMID: 36264323 PMCID: PMC9898330 DOI: 10.1007/s00296-022-05236-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/10/2022] [Indexed: 02/06/2023]
Abstract
This study aimed to determine the prevalence of foot health problems in people living with any rheumatic condition and explore potential associations with exposure variables. A cross-sectional observational epidemiological design was applied. The participants were recruited from one regional patient association in southwest Finland. The data were collected in January-February 2019 and included the Self-reported Foot Health Assessment Instrument (S-FHAI) and demographic questions. In total, 495 responses were obtained. Overall, participants had many foot problems. The point prevalence of self-reported foot problems was 99 per 100 people living with a rheumatic condition. The most prevalent problems were foot pain (73%), dry soles (68%), thickened toenails (58%) and cold feet (57%). Lower educational attainment, increased amount of daily standing and accessing medical or nursing care for foot problems were associated with poorer foot health. The results reveal a high frequency of foot pain among people with rheumatic conditions. The study highlighted the importance of person-centred care and the biological focus that underpins and impacts foot health (what we understand, what we do, and our health-seeking behaviour). Interventions to promote biopsychosocial approaches to personalised foot care could advance people's readiness, knowledge and skill to care for their own feet.
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Affiliation(s)
- Minna Stolt
- Department of Nursing Science, University of Turku, 20014 Turku, Finland
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Katja Kankaanpää
- Department of Nursing Science, University of Turku, 20014 Turku, Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Lindsey Cherry
- School of Health Sciences, University of Southampton, Southampton, UK
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15
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Reinoso-Cobo A, Ortega-Avila AB, Ramos-Petersen L, García-Campos J, Banwell G, Gijon-Nogueron G, Lopezosa-Reca E. Relationship between Kinesiophobia, Foot Pain and Foot Function, and Disease Activity in Patients with Rheumatoid Arthritis: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010147. [PMID: 36676771 PMCID: PMC9864291 DOI: 10.3390/medicina59010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
The main objective of the present study was to determine the relationship between kinesiophobia and pain (general and foot pain), foot function, and disease activity in patients with rheumatoid arthritis (RA). A total of 124 interviews were carried out with participants with RA. Participants were recruited from the Hospital Universitario Virgen de las Nieves de Granada in Spain. Interviews took place in January 2021. Participants completed the following questionnaires during an appointment with their rheumatologist: Foot Function Index (FFI), Tampa Scale for Kinesiophobia (TSK-11), and the Visual Analogue Scale Pain foot (VAS Pain). Furthermore, the Simplified Disease Activity Index (SDAI) was used to measure disease activity. Of the 124 participants, 73% were women, and their mean age was 59.44 years (SD 11.26 years). In the statistical analysis, positive linear correlations (p < 0.001) were obtained between the variables TSK-11 and VAS (related to general pain or foot pain) and FFI (in its three subscales). Additionally, a negative correlation between the TSK-11 and the educational background was shown. This study provided information about the relationship between foot function and pain with different levels of kinesiophobia in patients with RA. Additionally, the educational background of the patient was considered a predictor of whether or not a patient suffered from kinesiophobia.
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Affiliation(s)
- Andres Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Malaga, Spain
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
- Correspondence:
| | - Jonatan García-Campos
- Department of Behavioural Sciences and Health, University of Miguel Hernandez, 03202 Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - George Banwell
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Malaga, Spain
| | - Eva Lopezosa-Reca
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
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16
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Liu C, Cao G, Li J, Lian S, Zhao K, Zhong Y, Xu J, Chen Y, Bai J, Feng H, He G, Dong X, Yang P, Zeng F, Lin Z, Zhu S, Zhong X, Ma W, Liu T. Effect of long-term exposure to PM 2.5 on the risk of type 2 diabetes and arthritis in type 2 diabetes patients: Evidence from a national cohort in China. ENVIRONMENT INTERNATIONAL 2023; 171:107741. [PMID: 36628860 DOI: 10.1016/j.envint.2023.107741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND It remains unclear whether type 2 diabetes and the complication of arthritis are causally related to the PM2.5 pollutant. Therefore, we aimed to investigate the associations of long-term PM2.5 exposure with type 2 diabetes and with arthritis in type 2 diabetes patients. MATERIALS AND METHODS This study used data from the China Health and Retirement Longitudinal Survey (CHARLS) implemented during 2011-2018. The associations were analyzed by Cox proportional hazards regression models, and the population-attributable fraction (PAF) was calculated to assess the burden of type 2 diabetes and arthritis-attributable to PM2.5. RESULTS A total of 21,075 participants were finally included, with 19,121 analyzed for PM2.5 and type 2 diabetes risk and 12,427 analyzed for PM2.5 and arthritis risk, of which 1,382 with newly-diagnosed type 2 diabetes and 1,328 with arthritis during the follow-up. Overall, each 10 μg/m3 increment in PM2.5 concentration was significantly associated with an increase in the risk of type 2 diabetes (HR = 1.26, 95 %CI1.22 to 1.31), and the PAF of type 2 diabetes attributable to PM2.5 was 13.54 %. In type 2 diabetes patients, each 10 μg/m3 increment in PM2.5 exposure was associated with an increase in arthritis (HR = 1.42, 95 %CI: 1.28 to 1.57), and the association was significantly greater than that (H = 1.23, 95 %CI: 1.19 to 1.28) in adults without type 2 diabetes. The PAFs of arthritis-attributable to PM2.5 in participants with and without type 2 diabetes were 18.54 % and 10.69 %, respectively. CONCLUSION Long-term exposure to PM2.5 may increase the risk of type 2 diabetes and make type 2 diabetes patients susceptible to arthritis.
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Affiliation(s)
- Chaoqun Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ganxiang Cao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510080, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jieying Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Shaoyan Lian
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ke Zhao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ying Zhong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Jiahong Xu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Yumeng Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510080, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jun Bai
- Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan 528000, China
| | - Hao Feng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Xiaomei Dong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Pan Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ziqiang Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Xinqi Zhong
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China.
| | - Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China.
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17
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Laitinen AM, Pasanen M, Wasenius E, Stolt M. Foot self-care competence reported by patients with rheumatoid arthritis: a cross-sectional study. J Foot Ankle Res 2022; 15:93. [PMID: 36527154 PMCID: PMC9758871 DOI: 10.1186/s13047-022-00599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Foot self-care is important for preventing foot problems and maintaining one's foot health. Foot self-care requires competence to identify foot problems, knowledge and skills to care for those problems, and a willing attitude to care for one's foot health. However, there is major gap in the research evidence of foot self-care competence among patients with rheumatoid arthritis. This study aimed to analyse self-reported levels of competence in foot self-care among patients with rheumatoid arthritis. METHODS A cross-sectional study design was used. Data were collected using a survey consisting of a self-reported competence in foot self-care competence scale (response options on 5-point Likert scale, higher values indicate higher competence) and background questions. The data were analysed with descriptive and inferential statistics and the psychometric properties of the scale using Rasch analysis. RESULTS The participants' (n = 251) self-reported level of competence in foot self-care was moderate (mean 3.50, standard deviation [SD], 0.66). On the sum variable level, the highest mean score was for attitude towards foot self-care (3.98; SD, 0.69), followed by foot self-care knowledge (3.45; SD, 0.67) and experience providing foot self-care (3.38; SD, 0.69). Higher self-reported foot self-care knowledge and female sex were associated with higher self-reported competence in every sum variable. CONCLUSIONS Patients with rheumatoid arthritis evaluated their level of competence in foot self-care as moderate and some deficiencies were identified. These results indicate the importance of educating patients with rheumatoid arthritis about how to advance their foot self-care skills and knowledge. In the future, patients with rheumatoid arthritis could benefit from interventions that increase their knowledge of foot self-care together with practical examples, such as online videos, that demonstrate the practical conduct of foot self-care skills in daily life.
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Affiliation(s)
- Anne-Marie Laitinen
- grid.1374.10000 0001 2097 1371Department of Nursing Science, University of Turku, Turku, 20014 Finland ,grid.410552.70000 0004 0628 215XTurku University Hospital, Turku, Finland
| | - Miko Pasanen
- grid.1374.10000 0001 2097 1371Department of Nursing Science, University of Turku, Turku, 20014 Finland
| | - Elina Wasenius
- grid.425628.f0000 0001 1913 4955Podiatry, Metropolia University of Applied Sciences, Helsinki, Finland
| | - Minna Stolt
- grid.1374.10000 0001 2097 1371Department of Nursing Science, University of Turku, Turku, 20014 Finland ,grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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18
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Abdelzaher MG, Finzel S, Abdelsalam A, Enein AF, Abdelsalam N. Ankle and foot pathologies in early rheumatoid arthritis, what can ultrasound tell us? Int J Rheum Dis 2022; 25:1315-1323. [PMID: 36017618 DOI: 10.1111/1756-185x.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic autoimmune polyarticular disease. Despite being commonly affected in RA, the ankle and foot do not receive much attention, particularly in early disease. The precise diagnosis of their involvement and its impact on health is a clinical challenge that requires accurate assessment. AIM To determine the role of ultrasound in evaluation of ankle and foot pathologies and assess its impact on functional activity in newly diagnosed RA patients. METHODS The study was conducted on 152 RA patients and 52 healthy controls. Patients were subjected to history taking, clinical examination, and ultrasound scan. Impact on health was measured by health assessment questionnaire, as well as foot function index. RESULTS In a cohort of patients with early RA with median duration of 1 month, tibialis posterior (TP) tenosynovitis (45.4%) was the most common pathology, followed by tibiotalar (TTJ) synovitis (39.8%), and peroneal tenosynovitis (39.1%). In terms of disease duration, TTJ (P = .001) foot pathologies were less common in early RA and tended to worsen over time, whereas TP (P = .048) and peroneal tenosynovitis (P = .011) were more common in early RA. In multivariate analysis TTJ, subtalar synovitis, forefoot pathologies, TP tenosynovitis, and Achilles enthesitis were found to be significant predictors of functional disability. The most important predictors of ankle pain were TTJ synovitis, TP tenosynovitis, peroneal tenosynovitis, and plantar fasciitis. CONCLUSION Ankle and foot involvement is a common issue of early RA, and it has a significant impact on quality of life. Ultrasound is a reliable tool for evaluating various abnormalities in this complex area, allowing for better management.
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Affiliation(s)
- Mohamed Gamal Abdelzaher
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Adel Abdelsalam
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Asmaa Farouk Enein
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Noha Abdelsalam
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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19
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Kaniewska K, Kuryliszyn-Moskal A, Hryniewicz A, Moskal-Jasińska D, Wojciuk M, Dzięcioł-Anikiej Z. Static Foot Disturbances and the Quality of Life of Older Person with Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8633. [PMID: 35886484 PMCID: PMC9321945 DOI: 10.3390/ijerph19148633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
Disturbed static foot function is one of the main causes of impaired quality of life, which may be related to the frailty syndrome of older adult patients with Rheumatoid Arthitis (RA). The aim of the study was to evaluate the relationship between parameters of static foot function disturbances and quality of life of older adult patients with RA. The study was performed among 102 patients with RA diagnosed according to the American College of Rheumatology (ACR) and EULAR 2010 criteria. Patients were divided into four subgroups depending on radiological evaluation according to the Steinbrocker classification. Plantoconturography examination was conducted using a podoscope with a 3D scanner and software for computer foot examination CQ ST2K. Quality of life of patients with RA was evaluated using the Arthritis Impact Measurement Scales-2 (AIMS-2). A statistically significant relationship between AIMS-2 and parameters of static foot function disturbances was observed. The study revealed correlations between parameters of disturbed static foot function and RA severity in comparison to disease duration. Our results indicate a relationship between static foot function disturbances and quality of life of patients with RA, not only in the area of physical activity, but also in the social an emotional domain. Study results indicate that plantoconturography and assessment of quality of life using AIMS-2 could be useful as a diagnostic and prognostic tool in RA.
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Affiliation(s)
- Katarzyna Kaniewska
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
| | - Anna Kuryliszyn-Moskal
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
| | - Anna Hryniewicz
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
| | - Diana Moskal-Jasińska
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, 37 Szpitalna St., 15-276 Bialystok, Poland;
| | - Mariusz Wojciuk
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
| | - Zofia Dzięcioł-Anikiej
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
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20
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Hassel K. Unterschiede in der Therapie entzündlich rheumatischer und
degenerativer Füße. Die Vorfußchirurgie. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1814-4096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDer Unterschied zwischen rheumatischen und degenerativen Veränderungen am
Fuß liegt in der fortschreitenden Destruktion der Gelenke bei
persistierender Synovialitis der rheumatoiden Arthritis (RA). Unter der heute
wirksameren immunsuppressiven Therapie und eines frühen und aggressiven
Beginns zeigen sich mildere Verlaufsformen. So können zunehmend auch
gelenkerhaltende Verfahren der Vorfußchirurgie Anwendung finden.
Entscheidend ist hier jedoch die Remission mit sicherer Krankheitskontrolle
für den gelenkerhaltenden Eingriff. Dennoch ist das Rezidiv- und
Fehlstellungsrisiko aufgrund wiederkehrender arthritischer Phasen höher.
Rheumaorthopädische Standardverfahren, wie die Arthrodese des
Großzehengrundgelenkes mit Resektion der Metatarsaleköpfchen
haben aber Ihren Stellenwert beim Vollbild des erosiven rheumatischen
Vorfußes nicht verloren. Ein standardisiertes Vorgehen fehlt. Umso
wichtiger ist es, mit jedem Patienten individuell die richtigen
Maßnahmen zu festzulegen.
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Affiliation(s)
- Kathryn Hassel
- Orthopädische Rheumatologie, Vitos Orthopadische Klinik Kassel
gGmbH, Kassel, Germany
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21
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Rutkowski R, Gizińska M, Gałczyńska-Rusin M, Kasprzak MP, Budiman-Mak E. The Importance of Foot Function Assessment Using the Foot Function Index-Revised Short Form (FFI-RS) Questionnaire in the Comprehensive Treatment of Patients with Rheumatoid Arthritis. J Clin Med 2022; 11:2298. [PMID: 35566422 PMCID: PMC9101500 DOI: 10.3390/jcm11092298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Foot problems may have a substantial negative impact on rheumatoid arthritis (RA) patients' mobility. They affect walking and the functional capacity to perform daily tasks. METHODS This study included 61 patients with RA and foot pain or swelling. The study group comprised 37 patients (aged 54.3 ± 9.5 years) with foot lesions, as demonstrated in an ultrasound, and the control group comprised 24 patients (aged 57.3 ± 11.5 years) without foot lesions. The patients' health statuses were evaluated with the Foot Function Index-Revised Short Form (FFI-RS), the Polish version of the Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Disease Activity Score 28 (DAS 28). RESULTS The FFI-RS showed significant differences between the study and control groups in total results, as well as in the pain and stiffness subscales. Subsequent analyses showed numerous significant correlations. The FFI-RS total results correlated with the HAQ's standing up, walking, and total results. The FFI-RS pain results correlated with the social issues and HAQ's total results. The FFI-RS difficulty results correlated with the disease's duration. In the study group, there were significant correlations of the FFI-RS stiffness, difficulty, and social issues results with the HAQ's standing up, walking, and total results, and also of the FFI-RS activity limitation results with the HAQ's standing up results. In the control group, there were correlations of the FFI-RS stiffness, difficulty, and activity limitation results with the HAQ's walking and total results. Finally, in the study group, we also found correlations of the FFI-RS total, pain, stiffness, difficulty, and social issues results with the Visual Analog Scale (VAS) results, as well as of the FFI-RS total results with the DAS 28 results. CONCLUSIONS The FFI-RS is an effective tool for assessing RA patients' functional status and can be used to evaluate treatment effects. The FFI-RS detected RA-related changes in the foot joint function in patients without foot lesions, as assessed by ultrasound.
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Affiliation(s)
- Radosław Rutkowski
- Department of Physical Therapy and Sports Recovery, Poznan University of Physical Education, Królowej Jadwigi Str. 27/39, 61-871 Poznan, Poland;
| | - Małgorzata Gizińska
- Department of Physical Therapy and Sports Recovery, Poznan University of Physical Education, Królowej Jadwigi Str. 27/39, 61-871 Poznan, Poland;
| | - Małgorzata Gałczyńska-Rusin
- Department of Orthodontics and Temporomandibular Disorders, University of Medical Sciences, Bukowska 70, 60-812 Poznan, Poland;
| | - Magdalena Paulina Kasprzak
- Chair and Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806 Poznań, Poland;
| | - Elly Budiman-Mak
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, 5000 South 5th Ave, Hines, IL 60141-3030, USA;
- Department of Medicine, Stritch School of Medicine, Loyola University of Chicago, Maywood, IL 60513, USA
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22
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Dörner T, Vital EM, Ohrndorf S, Alten R, Bello N, Haladyj E, Burmester G. A Narrative Literature Review Comparing the Key Features of Musculoskeletal Involvement in Rheumatoid Arthritis and Systemic Lupus Erythematosus. Rheumatol Ther 2022; 9:781-802. [PMID: 35359260 PMCID: PMC9127025 DOI: 10.1007/s40744-022-00442-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/08/2022] [Indexed: 12/14/2022] Open
Abstract
Although the clinical approach to the management of musculoskeletal manifestations in systemic lupus erythematosus (SLE) is often similar to that of rheumatoid arthritis (RA), there are distinct differences in immunopathogenesis, structural and imaging phenotypes and therapeutic evidence. Additionally, there are few published comparisons of these diseases. The objective of this narrative literature review is to compare the immunopathogenesis, structural features, magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) studies and management of joint manifestations in RA and SLE. We highlight the key similarities and differences between the two diseases. Overall, the literature evaluated indicates that synovitis and radiographical progression are the key features in RA, while inflammation without swelling, tendinitis and tenosynovitis are more prominent features in SLE. In addition, the importance of defining patients with RA by the presence or absence of autoantibodies and categorizing patients with SLE by synovitis detected by musculoskeletal ultrasound and by structural phenotype (non-deforming, non-erosive arthritis, Jaccoud’s arthropathy and ‘Rhupus’) with respect to joint manifestations will also be discussed. An increased understanding of the joint manifestations in RA and SLE may inform evidence-based clinical decisions for both diseases.
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Affiliation(s)
- Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany.
| | - Edward M Vital
- Faculty of Medicine and Health, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, National Institute for Health Research, Leeds Teaching Hospitals, Leeds, UK
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rieke Alten
- Department of Internal Medicine and Rheumatology, Schlosspark-Klinik, Teaching Hospital of the Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ewa Haladyj
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
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23
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Chakraborty U, Hati A, Chandra A. Classical hand and foot deformities in rheumatoid arthritis. QJM 2022; 115:107-108. [PMID: 34904665 DOI: 10.1093/qjmed/hcab316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- U Chakraborty
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM, 52/1a, Sambhunath Pandit Street, Gokhel Road, Kolkata 700020, India
| | - A Hati
- Department of Internal Medicine, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata 700004, India
| | - A Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata 700004, India
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24
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Yumusakhuylu Y, Dogruoz Karatekin B, Turan Turgut S, Icagasioglu A, Selimoglu E, Murat S, Kasapoglu E, Turgut B. Pedobarographic Measurements of Rheumatoid Feet Compared with Clinical Parameters. Medeni Med J 2022; 37:99-104. [PMID: 35306796 PMCID: PMC8939449 DOI: 10.4274/mmj.galenos.2021.70750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: This study aimed to investigate the relationship between plantar pressure pedobarographic measurements and disease activity, radiological abnormalities, and foot indexes in patients with rheumatoid arthritis (RA). Methods: Sociodemographics, foot symptoms, anatomical distribution, pain intensity and duration, and podiatry services access data were collected. Disease activity scale of 28 joints (DAS28) was used for the disease activity, and Health Assessment Questionnaire (HAQ) was used for the functional status. Foot function index (FFI) was used to measure the impact of foot pathology on its function. The Modified Larsen scoring was used to assess radiological abnormalities. Pedobarographic measurements were used to analyze foot loading characteristics. Results: A total of 104 feet of 52 patients with RA was evaluated. DAS28 scores did not correlate with the plantar pressure values (p>0.05). A significant correlation was found between HAQ scores and right medial midfoot loading pressure (r=0.355; p<0.01). FFI scores were positively correlated with right lateral midfoot loading pressure (r=0.302; p<0.05). No relationship was found between Manchester Foot Pain and Disability Index and plantar loading characteristics. The radiological scores were correlated with left lateral hindfoot plantar pressure (r=0.286; p<0.05). Conclusions: Pedobarographic measurements can be considered as a follow-up evaluation tool for the evaluation of all foot parts (forefoot, midfoot, and hindfoot). Rheumatoid feet investigation showed that foot involvement is independent of the disease duration, whereas midfoot plantar pressures are associated with the body mass index. Additionally, DAS28 may fall short as a marker of disease activity because it neglects foot problems.
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25
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Repeatability and Reliability of the Rheumatoid Arthritis Foot Disease Activity Index in Spanish Patients: A Transcultural Adaptation. BIOLOGY 2021; 11:biology11010030. [PMID: 35053028 PMCID: PMC8773273 DOI: 10.3390/biology11010030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/23/2022]
Abstract
Simple Summary The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) is the first questionnaire designed to check the level of involvement in the feet of patients with rheumatoid arthritis. It is a validated and reliable five-question questionnaire in English. It is also considered suitable for clinical use. We aim was to translate and validate the Spanish version. The findings of this research suggest that is a valid, strong and trustworthy clinimetric tool that appropriately applies to the Spanish community and can be managed as a whole or in terms of its respective dimensions, such as arthritis activity in the foot, joint tenderness and swelling, and foot arthritis pain sub-scales. Abstract Background: The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) questionnaire, based on five questions, is used to assess the severity of rheumatoid arthritis disease in the foot. Nowadays, RADAI-F5 has been validated in different languages; however a Spanish version was lacking. Therefore, the purpose of this research was to translate and validate the Spanish version (RADAI-F5-es). Methods: A cross-cultural translation of the RADAI-F5 questionnaire was performed from English to Spanish. To validate its use, 50 subjects with rheumatoid arthritis who responded to the translated questionnaire two times in an interval of less than 3 months were selected in order to verify the psychometric properties. Results: Excellent agreement between the two versions according to the Cronbach’s α was shown. Five domains with regards to arthritis activity in foot joint tenderness and swelling, foot arthritis pain, general foot health and joint stiffness were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for joint stiffness on awakening and foot arthritis pain domains. There were no significant differences among any domains (p > 0.05). There were no statistically significant differences (p = 0.000) for the mean ± standard deviations (SD) between pre- and post-tests (98.09 ± 15.42) [93.75–102.43] and 97.96 ± 13.88 [94.5–101.86] points, respectively). Bland–Altman plots or clinically pertinent variations were not statistically significantly different. Conclusions: The RADAI-F5-es is considered a valid and strong tool with adequate repeatability in the Spanish community.
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26
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Partovifar M, Safaeepour Z, Bagherzadeh Cham M. The effect of pre-fabricated insole on plantar pressure distribution in patients with rheumatoid arthritis. Foot (Edinb) 2021; 49:101832. [PMID: 34687978 DOI: 10.1016/j.foot.2021.101832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Foot deformities result in pain and changes in plantar pressure distribution in rheumatoid arthritis (RA) patients. Medical insoles are commonly prescribed for declining pain and modifying foot pressure distribution in these patients. The purpose of this study was to evaluate the effect of a pre-fabricated insole with metatarsal pad and medial longitudinal arch support on plantar pressure distribution in rheumatoid arthritis patients. METHODS Fifteen females with RA participated in this study. All patients received a pair of pre-fabricated insoles that were individually modified using metatarsal pads and medial longitudinal arch supports. Mean peak pressure (kPa), maximum force (N), and contact area (cm2) were calculated for the heel, midfoot, metatarsophalangeal joint, and toe regions using the Pedar-X system immediately and after a month follow-up. FINDINGS In the heel and metatarsophalangeal joint regions, maximum pressure and force showed a significant reduction in the follow-up assessment (p < 0.05). The comparison showed a significant increase in maximum pressure and force in the midfoot when participants walked with insole compared to without insole condition (p < 0.001). INTERPRETATION Using a pre-fabricated insole with an individually modified metatarsal pad and medial longitudinal arch support could alter rheumatoid arthritis patients' plantar pressures after one month of follow-up. This type of insole is simple and inexpensive and showed a significant effect on decreasing pressures under the metatarsal heads.
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Affiliation(s)
- Maryam Partovifar
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Zahra Safaeepour
- Department of Human Performance and Health, University of South Carolina Upstate, Spartanburg, SC, United States.
| | - Masumeh Bagherzadeh Cham
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Firozgar Hospital, Iran University of Medical Sciences, Tehran, Iran; Department of Orthotics & Prosthetics, Iran University of Medical Sciences, Tehran, Iran.
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27
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Stolt M, Kielo-Viljamaa E, Laitinen AM, Suhonen R, Leino-Kilpi H. Reporting of Research Ethics in Studies Focusing on Foot Health in Patients with Rheumatoid Arthritis - A Systematic Review. J Empir Res Hum Res Ethics 2021; 17:39-51. [PMID: 34647510 PMCID: PMC8721538 DOI: 10.1177/15562646211047654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research ethics is a fundamental part of the entire research. Patients with rheumatoid arthritis are sensitive group of research participants because their long-term health problems cause significant changes in their foot health. In foot health research, data are usually collected through a clinical assessment of the foot or questionnaires. However, there is limited evidence of the reported research ethics of empirical studies on foot health in patients with rheumatoid arthritis. Therefore this review aimed to analyze the reported research ethics of peer-reviewed empirical studies focusing on foot health in patients with rheumatoid arthritis as research participants. This systematic review used the Medline/PubMed, CINAHL, and Embase databases. A total of 1,653 records were identified, and 32 articles were included in the final analysis. Reporting research ethics in studies of patients with rheumatoid arthritis is fragmented, focusing predominantly on ethical approval and informed consent and lacking a broader discussion about research ethics.
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Affiliation(s)
| | | | | | - Riitta Suhonen
- 8058University of Turku, Turku (Finland).,60652Turku University Hospital, Turku (Finland).,96892City of Turku, Turku (Finland)
| | - Helena Leino-Kilpi
- 8058University of Turku, Turku (Finland).,60652Turku University Hospital, Turku (Finland)
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28
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Stolt M, Kilkki M, Katajisto J, Suhonen R. Self-assessed foot health in older people with rheumatoid arthritis-A cross-sectional study. Int J Older People Nurs 2021; 16:e12380. [PMID: 34008331 DOI: 10.1111/opn.12380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Foot and ankle problems are especially common in patients with RA, causing significant disability and limitation in daily activities. Previous studies have mainly focussed on foot problems in the adult population whilst the evidence of foot health in the older population is scarce. OBJECTIVES The aim of the study was to analyse self-assessed foot health and associated factors in older people with rheumatoid arthritis (RA). METHODS The study applied a descriptive cross-sectional survey design and recruited older people with RA from the member register of one patient association. We collected the data in January 2019 with the Self-administered Foot Health Assessment Instrument, and sociodemographic and foot-related background questions and analysed the data with descriptive and inferential statistics. RESULTS Older people with RA had many self-reported foot problems. The most common problems were foot pain, dry skin and thickened toenails. In addition, structural deformities of the foot were prevalent. The level of foot health associated with the amount of daily walking or standing, and using walking or running shoes outdoors. Individuals who had consulted a physician due to their foot problems had more structural deformities in the foot. Foot problems limited their ability to perform daily activities. CONCLUSIONS This study demonstrates that older people with RA not only live with a long-term health condition, but they also live with complex foot problems. Older people with RA need healthcare services due to their foot problems. There is a need to develop and implement care practices to alleviate foot pain and support and promote foot health and functional ability in older people with RA. IMPLICATION FOR PRACTICE Understanding the nature and consequences of foot problems in older people with RA allows healthcare professionals to perform more accurate clinical foot evaluations and develop effective interventions to prevent further foot problems.
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Affiliation(s)
- Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Mia Kilkki
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,Welfare Division, City of Turku, Turku, Finland
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29
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Reina-Bueno M, Munuera-Martínez PV, Pérez-García S, Vázquez-Bautista MDC, Domínguez-Maldonado G, Palomo-Toucedo IC. Foot Pain and Morphofunctional Foot Disorders in Patients with Rheumatoid Arthritis: A Multicenter Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095042. [PMID: 34068737 PMCID: PMC8126220 DOI: 10.3390/ijerph18095042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
Foot problems are highly prevalent in people with rheumatoid arthritis. This study aims to explore the foot morphology, pain and function in rheumatoid arthritis patients and the relation with the time of disease debut. A cross-sectional study was designed. Footprint, the Foot Posture Index, the hallux valgus prevalence, foot pain and function in 66 rheumatoid arthritis patients and the association with time since diagnosis, were recorded. The Foot Function Index, the Manchester Foot Pain and Disability Index, the Visual Analogic Scale, and the Manchester Scale for hallux valgus were administered and analyzed in two groups, with less and more than 10 years of diagnosis of the disease. A high prevalence of pronated (right 36.8% and left 38.6%) and highly pronated (right 15.8% and left 15.8%) feet was observed, as well as an elevated percentage of low arched footprints (right 68.4 and left 66.7%) and hallux valgus (right 59.6% and left 54.4%). Hallux valgus prevalence, toe deformities and Foot Function Index (Functional limitation) factors were significantly associated with the time since RA diagnosed adjusted for the other factors. The adjusted odds ratio of Hallux valgus prevalence was 4.9 (1.2-19.7). In addition, the foot function was diminished, and foot pain was present in most participants. In conclusion, rheumatoid arthritis patients' feet showed altered morphology and function, and with longer rheumatoid arthritis history, metatarsophalangical stability and foot function, but not pain and global foot posture, were likely to deteriorate.
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Affiliation(s)
- María Reina-Bueno
- Department of Podiatry, University of Seville, 41004 Seville, Spain; (P.V.M.-M.); (M.d.C.V.-B.); (G.D.-M.); (I.C.P.-T.)
- Correspondence:
| | - Pedro V. Munuera-Martínez
- Department of Podiatry, University of Seville, 41004 Seville, Spain; (P.V.M.-M.); (M.d.C.V.-B.); (G.D.-M.); (I.C.P.-T.)
| | - Sergio Pérez-García
- Department of Health Sciences, University of A Coruña, 15001 A Coruña, Spain;
| | | | - Gabriel Domínguez-Maldonado
- Department of Podiatry, University of Seville, 41004 Seville, Spain; (P.V.M.-M.); (M.d.C.V.-B.); (G.D.-M.); (I.C.P.-T.)
| | - Inmaculada C. Palomo-Toucedo
- Department of Podiatry, University of Seville, 41004 Seville, Spain; (P.V.M.-M.); (M.d.C.V.-B.); (G.D.-M.); (I.C.P.-T.)
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Sanchez-Castillo JA, Reinoso-Cobo A, Gijon-Nogueron G, Caliz-Caliz R, Exposito-Ruiz M, Ramos-Petersen L, Ortega-Avila AB. Symmetry Criterion for Patients with Rheumatoid Arthritis of the Foot: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073619. [PMID: 33807259 PMCID: PMC8036999 DOI: 10.3390/ijerph18073619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
Objective: The aim of the study was to analyze the feet of rheumatoid arthritis (RA) patients, to determine the degree to which both feet were affected, primarily analyzing the severity of RA in both feet looking at structure and morphology, and secondly looking at the symmetry in terms of the anthropometrics and posture. Method: This cross-sectional study was conducted from January to December 2018. The data from 229 patients with RA and with foot pain and no RA recruited (Granada, Spain) were analyzed. Two researchers independently interviewed the patients to obtain the study data. The clinical data were obtained using specific foot health and quality of life questionnaires and a validated platform for foot measurement. Anthropometric measurements were obtained by means of a foot measurement platform and the Foot Posture Index (FPI). The bivariate analysis was performed with the Student’s t test and the non-parametric Wilcoxon test. The level of significance was established at p < 0.05. Results: In the RA group, anthropometric measurements revealed significant differences between the left and right feet in 13 of the 23 parameters considered, as follows: (non-load-bearing) foot length, length of the first metatarsophalangeal joint, maximum height of the internal longitudinal arch, and width of the midfoot (p < 0.001, p = 0.038, p < 0.001, and p = 0.037 respectively); and Foot Posture Index (p = 0.001). Conclusions: In patients with RA, statistically significant differences were found in the Foot Posture Index and in several parameters related to foot structure and morphology. From this, we conclude that from a morphological, structural, and postural standpoint, a pattern of symmetric joint involvement should not be viewed as a specific criterion for RA in the foot.
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Affiliation(s)
- Jose Alberto Sanchez-Castillo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29071 Málaga, Spain; (J.A.S.-C.); (A.R.-C.); (A.B.O.-A.)
| | - Andres Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29071 Málaga, Spain; (J.A.S.-C.); (A.R.-C.); (A.B.O.-A.)
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29071 Málaga, Spain; (J.A.S.-C.); (A.R.-C.); (A.B.O.-A.)
- Biomedical Research Institute (IBIMA), 29010 Malaga, Spain
- Correspondence:
| | - Rafael Caliz-Caliz
- Department of Rheumatology, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | - Manuela Exposito-Ruiz
- Departamento de Estadística e Investigación Operativa, Universidad de Granada, 18100 Granada, Spain;
| | - Laura Ramos-Petersen
- Department of Podiatry, Faculty of Health Sciences, Universidad Catolica San Antonio de Murcia, 30107 Murcia, Spain;
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29071 Málaga, Spain; (J.A.S.-C.); (A.R.-C.); (A.B.O.-A.)
- Biomedical Research Institute (IBIMA), 29010 Malaga, Spain
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Structural and Functional Changes of Hands and Legs in Early Rheumatoid Arthritis. ACTA ACUST UNITED AC 2021; 57:medicina57040317. [PMID: 33800568 PMCID: PMC8066246 DOI: 10.3390/medicina57040317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/19/2022]
Abstract
Background and Objectives: The aim of this study was to assess if there are structural and functional changes of hands and legs already in early rheumatoid arthritis (ERA), compared with the population-based control group. Additionally, we aimed to identify if the changes are symmetrical in hands and legs and if there are factors that are associated with these changes. The study was conducted, and, thus far, the results have been controversial. Materials and Methods: The study group consisted of 83 consecutive patients with ERA and 321 control subjects. Dual-Energy X-Ray Absorptiometry (DXA) machine was used to measure bone, lean and fat mass. Inflammation and bone markers, smoking and nutritional habits were assessed, to evaluate the effects of different factors. The 30-Second Chair Stand Test (30-CST) and the Handgrip Strength Test (HST) were used to estimate muscle strength. Results: The presence of ERA was associated with lower arm, leg lean mass and higher fat mass of arm, compared with control subjects. ERA was also associated with lower mean handgrip in HST and worse muscle strength of legs in the 30-CST. Bone mass changes were not so evident both in arms and legs. Smoking habits did not seem to have relevant effect on bone mass, muscle structural and functional changes, both on hands and legs. In ERA, lean mass of arm and leg was negatively associated with C-reactive protein (CRP). The intake of proteins in ERA was not associated with lean mass changes both in hands and legs. Conclusions: Structural and functional changes of hands and legs are different in ERA. ERA patients had higher fat mass of arm, lower lean mass of arm and leg and, accordingly, decreased muscle function. The lowering of lean mass of arm and leg in ERA was associated with the elevation of CRP.
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Huijbrechts EJ, Dekker J, Tenten-Diepenmaat M, Gerritsen M, van der Leeden M. Clinical guidance for podiatrists in the management of foot problems in rheumatic disorders: evaluation of an educational programme for podiatrists using a mixed methods design. J Foot Ankle Res 2021; 14:15. [PMID: 33632287 PMCID: PMC7908782 DOI: 10.1186/s13047-020-00435-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/16/2020] [Indexed: 01/18/2023] Open
Abstract
Background Foot and ankle problems are common in rheumatic disorders and often lead to pain and limitations in functioning, affecting quality of life. There appears to be large variability in the management of foot problems in rheumatic disorders across podiatrists. To increase uniformity and quality of podiatry care for rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthritis (SpA), and gout a clinical protocol has been developed. Research objectives [1] to evaluate an educational programme to train podiatrists in the use of the protocol and [2] to explore barriers and facilitators for the use of the protocol in daily practice. Method This study used a mixed method design and included 32 podiatrists in the Netherlands. An educational programme was developed and provided to train the podiatrists in the use of the protocol. They thereafter received a digital questionnaire to evaluate the educational programme. Subsequently, podiatrists used the protocol for three months in their practice. Facilitators and barriers that they experienced in the use of the protocol were determined by a questionnaire. Semi-structured interviews were held to get more in-depth understanding. Results The mean satisfaction with the educational programme was 7.6 (SD 1.11), on a 11 point scale. Practical knowledge on joint palpation, programme variation and the use of practice cases were valued most. The protocol appeared to provide support in the diagnosis, treatment and evaluation of foot problems in rheumatic disorders and the treatment recommendations were clear and understandable. The main barrier for use of the protocol was time. The protocol has not yet been implemented in the electronic patient file, which makes it more time consuming. Other experienced barriers were the reimbursement for the treatment and financial compensation. Conclusions The educational programme concerning the clinical protocol for foot problems in rheumatic disorders appears to be helpful for podiatrists. Podiatrists perceived the protocol as being supportive during patient management. Barriers for use of the protocol were identified and should be addressed prior to large scale implementation. Whether the protocol is also beneficial for patients, needs to be determined in future research.
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Affiliation(s)
- E J Huijbrechts
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands. .,Fontys University of applied sciences
- Department of allied health professionals, Fontys Paramedische Hogeschool, Eindhoven, The Netherlands.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - M Tenten-Diepenmaat
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands.,Saxion University of applied sciences
- department of healthcare, Saxion, Enschede, The Netherlands
| | - M Gerritsen
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands
| | - M van der Leeden
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
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33
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Gaino JZ, Bértolo MB, Nunes CS, Barbosa CDM, Landim SF, Sachetto Z, Magalhães EDP. The effect of foot orthoses on balance, foot function, and mobility in rheumatoid arthritis: A randomized controlled clinical trial. Clin Rehabil 2021; 35:1011-1020. [PMID: 33586475 DOI: 10.1177/0269215521993316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare balance, foot function and mobility in patients with rheumatoid arthritis with and without foot orthoses. DESIGN Randomized controlled trial. SETTING Outpatient rheumatology clinic. SUBJECTS A total of 94 subjects with rheumatoid arthritis were randomized; of these, 81 were included in the analyses (Intervention group: 40; Control group: 41). INTERVENTION The Intervention Group received custom-made foot orthoses while the Control Group received none intervention. MAIN MEASURE The "Foot Function Index," the "Berg Balance Scale," and the "Timed-up-and-go Test" were assessed at baseline an after four weeks. The chosen level of significance was P < 0.05. RESULTS Average (standard deviation) participant age was 56.7 (±10.6) years old and average disease duration (standard deviation) was 11.4 (± 7.2) years. Groups were similar at baseline, except for comorbidity index and race. After four weeks, significant interaction group versus time was observed for Foot Function Index (change: Intervention group: -1.23 ± 1.58; Control group: -0.12 ± 1.16 - P = 0.0012) and for Berg Balance Scale (change: Intervention group: 2 ± 3; Control group: 0 ± 3 - P = 0.0110), but not for the Timed-up-and-go Test (change: Intervention group: -1.34 ± 1.99; Control group: -0.84 ± 2.29 - P = 0.0799). CONCLUSION Foot orthoses improved foot function and balance in patients with rheumatoid arthritis.
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Affiliation(s)
- Juliana Zonzini Gaino
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Manoel Barros Bértolo
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Caroline Silva Nunes
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Cecília de Morais Barbosa
- Department of Internal Medicine, Gerontology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Síbila Floriano Landim
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Zoraida Sachetto
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Eduardo de Paiva Magalhães
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
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Reinoso-Cobo A, Anttila P, Ortega-Avila AB, Cervera-Garvi P, Lopezosa-Reca E, Marchena-Rodriguez A, Ramos-Petersen L, Gijon-Nogueron G. Morpho-structural characteristics of feet in patients with rheumatoid arthritis: A cross sectional study. Int J Med Sci 2021; 18:2269-2275. [PMID: 33967602 PMCID: PMC8100651 DOI: 10.7150/ijms.56935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Objective: The aim of this study was to evaluate and classify the types and incidences of foot deformities in patients with Rheumatoid Arthritis (RA). Methods: A cross-sectional study with convenience sample was obtained of 220 patients with foot pain and RA classification criteria (approved by the American College of Rheumatology and the European League against Rheumatism in 2010). A series of outcomes were assessed to measure the morphological characteristics of the feet. The Foot Posture Index (FPI), the Manchester Scale of Hallux Valgus and the Nijmegen classification of forefoot disorders were assessed. Results: The most common foot posture according to the FPI assessment are the pronated position in the left foot (32.7% of participants) and the neutral position in the right foot (34.1% of participants). The disease progression causes more developed and serious foot deformities. 1.82% of patients present a severe level of Hallux Valgus before 10 years of disease evolution whereas 4.09% of patients present a severe level of Hallux Valgus after 10 years of disease evolution. Conclusions: The most common foot type in patients with RA is the pronated foot type with deformities in the MTP joints without Hallux Valgus. However, a percentage of patients with RA presents supinated foot type. The evolution of the disease shows some morphological changes in terms of patient's feet. The presence of more developed foot deformities is increased, such us Hallux Valgus or MTP joints deformity (Grade 3 in the Nijmegen classification scale).
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Affiliation(s)
- Andres Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Pekka Anttila
- Applied Science of Metropolia Univesity, Podiatry Department, 01600 Helsinki, Finland
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.,IBIMA. Malaga, Spain
| | - Pablo Cervera-Garvi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Eva Lopezosa-Reca
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Ana Marchena-Rodriguez
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Laura Ramos-Petersen
- Departamento of Podiatry. Faculty of Health Sciences. Universidad Católica San Antonio de Murcia. Campus de Los Jerónimos. Guadalupe 30107 Murcia Spain
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.,IBIMA. Malaga, Spain
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Stolt M, Laitinen AM, Ruutiainen J, Leino-Kilpi H. Research on lower extremity health in patients with multiple sclerosis: a systematic scoping review. J Foot Ankle Res 2020; 13:54. [PMID: 32854741 PMCID: PMC7457257 DOI: 10.1186/s13047-020-00423-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/20/2020] [Indexed: 12/25/2022] Open
Abstract
Background Multiple sclerosis (MS) often affects ambulation and the function of the lower limbs. However, little is known about how much research has been conducted on lower extremity health in patients with MS. Objective To analyse empirical studies and their evidence on lower extremity health in patients with MS, in order to identify the need for future studies in key areas. Methods A systematic scoping review was conducted. A literature search of Medline (PubMed), CINAHL (EBSCO) and the Cochrane Library databases was performed. The search covered the period up to 15 January 2020 from the earliest records available. This led to the inclusion of 42 empirical articles. The data were analysed using content analysis and quantification techniques. Results The research on lower extremity health focused primarily on two main areas: gait and lower extremity muscle strength. Lower extremity health was assessed using a variety of methods, most of which consisted of objective physical tests and gait analysis. Patients with MS had many problems with the health of their lower extremities, which manifested in walking difficulties, balance problems, muscle weaknesses and spasticity. In the feet, pes cavus, claw toes, oedema and altered foot sensation were common. Conclusions MS affects lower limb and foot health, and these problems can affect patients’ daily lives. However, the extent of these problems is poorly understood, partly due to the dearth of research on lower limb and foot health. Therefore, further research is warranted in order to better understand the impact of MS on foot and lower limb health in everyday life.
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Affiliation(s)
- Minna Stolt
- Department of Nursing Science, University of Turku, 20014, Turku, Finland.
| | - Anne-Marie Laitinen
- Department of Nursing Science, University of Turku, 20014, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Juhani Ruutiainen
- Finnish Neuro Society, Masku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, 20014, Turku, Finland.,Turku University Hospital, Turku, Finland
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Fujii K, Stolt M. Intervention study of a foot-care programme enhancing knowledge and practice among nurses and care workers at in-home service providers. Nurs Open 2020; 7:1039-1051. [PMID: 32587723 PMCID: PMC7308698 DOI: 10.1002/nop2.479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Aim To evaluate the foot-care educational programme for nurses and care workers at in-home service providers. Design A non-randomized controlled study with random cluster sampling method. Methods Study participants were nurses and care workers of 21 in-home service providers, including home-visit nursing and care providers, 1-day care service centres or care centres with rehabilitation programme in Japan. Foot-care programme with foot-care tools as a package or standard care comprising 3-5 sessions over 2 months was provided to 110 participants (87 were on analysis). The outcomes were changes in foot-care knowledge and scores in pre-post interventions. Data were analysed with descriptive statistics, t test, logistic regression analysis and ANCOVA. Results Before adjusting for background, total scores of knowledge and practice categories were higher than the baseline in the intervention group (43 participants) compared with the control group (44 participants). After background correction due to potential bias of non-random cluster sampling, significant between group differences were observed in mean score changes in skin and consultation subscales of the practice category.
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Affiliation(s)
- Kashiko Fujii
- Graduate School of MedicineSchool of Health SciencesNagoya UniversityNagoya CityJapan
- University of Human EnvironmentsObuJapan
| | - Minna Stolt
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Turku University HospitalTurkuFinland
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Reinoso-Cobo A, Gijon-Nogueron G, Caliz-Caliz R, Ferrer-Gonzalez MA, Vallejo-Velazquez MT, Miguel Morales-Asencio J, Ortega-Avila AB. Foot health and quality of life in patients with rheumatoid arthritis: a cross-sectional study. BMJ Open 2020; 10:e036903. [PMID: 32423942 PMCID: PMC7239514 DOI: 10.1136/bmjopen-2020-036903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The aim of this study is to identify foot health factors related to the quality of life in patients with rheumatoid arthritis (RA). SETTING In this cross-sectional study, a total of 293 subjects were analysed, 229 of whom were in the RA group and 64 in the control group. In the RA group, 173 patients were female, and 50 in the control group. PARTICIPANTS Patients with foot pain and RA (according to the American College of Rheumatology/European League Against Rheumatism 2010 rheumatoid arthritis classification criteria) and with foot pain but no RA were recruited (Granada, Spain). INTERVENTION Two researchers independently interviewed the patients to obtain data for the study. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical data were obtained using the Short Form 12-Item questionnaire (quality of life) (primary outcome), Visual Analogue Scale for pain (VAS pain), the Manchester Foot Pain Disability Index (MFPDI) and the Foot Function Index (FFI). Anthropometric measurements were obtained using a foot measurement platform, the Foot Posture Index and the Manchester Scale of Hallux Valgus (secondary outcomes). RESULTS Of the 293 subjects, 76.1% were female. Significant differences were observed between the RA and the control group (p<0.001) with regard to VAS pain (general, foot and hand), MFPDI and FFI. In terms of anthropometric measurements, significant differences were only recorded for midfoot and forefoot width (p=0.03). For the physical health component, multivariable linear regression with the parameters age, gender, VAS pain (general) and the presence of RA presented an R2 value of 48.8%, while for the mental health component the corresponding value was 5.6%. CONCLUSION Morphological and structural characteristics of the foot are not necessarily associated with pain, disability and loss of function. The presence of RA, a higher score on VAS pain (general), female gender and older age are all associated with the physical component of the quality of life of patients with RA.
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Affiliation(s)
- Andres Reinoso-Cobo
- Departamento de Reumatologia, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Gabriel Gijon-Nogueron
- Department Nursing and Podiatry, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Rafael Caliz-Caliz
- Departamento de Reumatologia, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - Jose Miguel Morales-Asencio
- Department Nursing and Podiatry, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
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38
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Laitinen AM, Boström C, Hyytiä S, Stolt M. Experiences of foot health in patients with rheumatoid arthritis: a qualitative study. Disabil Rehabil 2020; 44:88-95. [DOI: 10.1080/09638288.2020.1758966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Sasu Hyytiä
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
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39
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Ortega-Avila AB, Moreno-Velasco A, Cervera-Garvi P, Martinez-Rico M, Chicharro-Luna E, Gijon-Noqueron G. Surgical Treatment for the Ankle and Foot in Patients with Rheumatoid Arthritis: A Systematic Review. J Clin Med 2019; 9:E42. [PMID: 31878151 PMCID: PMC7019508 DOI: 10.3390/jcm9010042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
The aim was to identify effective surgical treatments for patients with rheumatoid arthritis in the foot and/or ankle. A systematic review of the literature was conducted via a data search of the PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PROSPERO databases, from their inception until June 2019. Only non-randomized controlled trials and cohort studies were included in this review. Two of the present authors independently assessed the quality of each study and extracted the relevant data. A quality assessment of all articles was performed using the methodological index for non-randomized studies criteria. In addition, the Newcastle Ottawa scale was used for cohort studies. Thirteen studies met the inclusion criteria (five cohort studies and eight NRCTs). The total population considered was 923 patients (570 patients had RA), with a mean age of 58.8 years. Regarding the risk of bias, both the NRCTs and the cohort studies had a moderate level of quality. Despite the relatively low quality of these studies, surgical treatment for the foot and/or ankle is shown to reduce pain and improve functionality in patients with RA, in the short term (6-12 months).
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Affiliation(s)
- Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Antonio Moreno-Velasco
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Pablo Cervera-Garvi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Magdalena Martinez-Rico
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Esther Chicharro-Luna
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, San Juan de Alicante, 03550 Alicante, Spain;
| | - Gabriel Gijon-Noqueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
- Biomedical Research Institute (IBIMA), 29010 Malaga, Spain
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40
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de Andrade AP, Inoue EN, Nisihara R, Skare TL. Foot function in rheumatoid arthritis patients: a cross-sectional study. Clin Rheumatol 2018; 37:3427-3430. [PMID: 30008127 DOI: 10.1007/s10067-018-4215-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 11/26/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic disease that affects mainly small joints from hands and feet. The aims of this study were to analyze the prevalence of foot involvement in a sample of Brazilian RA patients and to explore the influence of disease variables such as inflammatory activity, serological, and epidemiological profile in this type of involvement. One hundred RA patients and 100 healthy controls paired for gender, age, and body mass index answered the FFI-BR (Foot Functional Index-Brazilian version) that evaluates foot function. RA patients had epidemiological and clinical data collection upon direct questioning and chart review. C-reactive protein (CRP), ESR (erythrocyte sedimentation rate), and DAS28-ESR were used to measure disease activity. In the RA sample, 98% had foot pain versus 76% in the controls (p < 0.0001; OR = 15.4; 95% CI = 3.4-67.5); 96% had some difficulty in function versus 66% of controls (p < 0.0001; OR = 12.3; 95% CI = 4.1-36.5); and 73% had some incapacity versus 20% of controls (p < 0.0001; OR = 10.8; 95% CI = 5.5-20.9). Values of FFI-BR showed correlation with ESR (p = 0.006), CRP (p = 0.01), and DAS28-ESR (p < 0.0001). No association between FFI-BR total score and gender, ethnic background, positive rheumatoid factor, tobacco exposure, and any of used medications was found (all p = ns). The majority of RA patients suffers from foot problems and was associated with inflammatory biomarkers. The control of inflammatory activity may help in the treatment of this problem.
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Affiliation(s)
- Agnes Patricia de Andrade
- Rheumatology Service, Medicine Department, Evangelic University Hospital of Curitiba, R. Padre Agostinho, 2770, Curitiba, 80730-000, Brazil
| | - Elinah Narumi Inoue
- Rheumatology Service, Medicine Department, Evangelic University Hospital of Curitiba, R. Padre Agostinho, 2770, Curitiba, 80730-000, Brazil
| | - Renato Nisihara
- Rheumatology Service, Medicine Department, Evangelic University Hospital of Curitiba, R. Padre Agostinho, 2770, Curitiba, 80730-000, Brazil.
- Department of Medicine, Positivo University, Curitiba, Brazil.
| | - Thelma Larocca Skare
- Rheumatology Service, Medicine Department, Evangelic University Hospital of Curitiba, R. Padre Agostinho, 2770, Curitiba, 80730-000, Brazil
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Rondina RG, de Mello RAF, Valim V, Lourenco RB, Batista EFP, de Oliveira Júnior R. Discordance between clinical and imaging criteria: assessment by magnetic resonance imaging of the foot of patients with rheumatoid arthritis. Rheumatol Int 2017; 37:1357-1364. [PMID: 28551722 DOI: 10.1007/s00296-017-3754-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
Evaluation of the correlation between disease activity and joint involvement was assessed by MRI in the clinically dominant foot of patients with RA. We conducted a cross-sectional descriptive study of 55 patients with RA, who were subjected to clinical evaluation and MRI assessment. Imaging of the clinically dominant foot was performed, and both the Disease Activity Score 28 (DAS28-CRP) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) were measured. The majority of patients classified as in clinical remission presented some degree of inflammatory activity upon MRI evaluation. Statistical analysis demonstrated no correlation between MRI findings and clinical scores. There is evidence of disease activity on MRI of the clinically dominant foot even in patients classified as in clinical remission according to the DAS28-CRP criteria.
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Affiliation(s)
- Ronaldo Garcia Rondina
- Department of Internal Medicine, Federal University of Espírito Santo, Rua Júlio Cesar de Oliveira Serrano, no. 135, apto 302-3, Vitória, ES, 29065-720, Brazil.
| | - Ricardo Andrade Fernandes de Mello
- Department of Internal Medicine, Federal University of Espírito Santo, Rua Júlio Cesar de Oliveira Serrano, no. 135, apto 302-3, Vitória, ES, 29065-720, Brazil
| | - Valeria Valim
- Department of Internal Medicine, Federal University of Espírito Santo, Rua Júlio Cesar de Oliveira Serrano, no. 135, apto 302-3, Vitória, ES, 29065-720, Brazil
| | | | - Elton Francisco Pavan Batista
- Department of Internal Medicine, Federal University of Espírito Santo, Rua Júlio Cesar de Oliveira Serrano, no. 135, apto 302-3, Vitória, ES, 29065-720, Brazil
| | - Ronaldo de Oliveira Júnior
- Department of Internal Medicine, Federal University of Espírito Santo, Rua Júlio Cesar de Oliveira Serrano, no. 135, apto 302-3, Vitória, ES, 29065-720, Brazil
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