Living with foot and ankle disorders in rheumatic and musculoskeletal diseases: A systematic review of qualitative studies to inform the work of the OMERACT Foot and Ankle Working Group

'Gout was like the boss'. A qualitative study exploring the impact of gout on employment

OBJECTIVE

Previous research has identified that gout impacts various domains of daily life. However, there have been no qualitative studies focusing on employment. This study aimed to understand the impact of gout on employment.

METHODS

Semistructured interviews were conducted in Spain and Aotearoa/New Zealand, in people with gout (according to the 2015 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria) who had experienced a gout flare during their employment. The interviews were guided by questions exploring the impact on employment, job changes, disclosure and co-workers' reactions. Data were analysed thematically.

RESULTS

Eighteen participants were interviewed (89% male, mean age 52.9 years). Six themes were identified. The characteristics of the disease (pain intensity, tophi and joints affected) and the job itself (including physical job requirement and workplace flexibility) determined the experience of working with gout. The experiences were divided into physical (from total incapacity to working despite pain), emotional (feeling responsible, embarrassment, guilt and depression) and social (including disclosure responses and financial impact). Gout management strategies including rapid gout flare management and urate-lowering therapy reduced the number of flares and the intensity of pain, and allowed work attendance and participation.

CONCLUSION

Both gout and work characteristics influence the employment experience for people with gout. Effective management of gout led to improved work experiences in all its domains.

Association of Foot Health and Lower Extremity Function in Older People with Rheumatoid Arthritis: A Cross-Sectional Study

INTRODUCTION

Foot health and lower extremity function are important in older people with rheumatoid arthritis (RA), as they maintain and promote these individuals' independent living and functional health. RA is a long-term inflammatory health condition that alters foot structure and function. Relatively little is known about the association between foot health and lower extremity function in older people with RA. Therefore, the aim of the study was to analyse the levels of foot health and lower extremity function in older people with RA and to explore the associations between these factors.

METHODS

A cross-sectional survey design study was conducted. The data were collected online in April 2023 from a national association of patients with rheumatic conditions in Finland using two instruments: the Self-administered Foot Health Assessment Instrument (S-FHAI) and the Lower Extremity Function Scale (LEFS). The data were analysed using descriptive and inferential statistics.

RESULTS

Older people with RA (n = 270) reported many foot health problems, the most common of which were foot pain, dry skin, and oedema. Lower extremity function in older people with RA was at the mild-to-moderate functional limitation level and respondents reported major difficulties running or hopping, squatting, carrying out their usual hobbies, performing strenuous activities outside their homes or putting on shoes/socks. Poor levels of foot health were correlated with decreased lower extremity function.

CONCLUSION

Foot health is associated with lower extremity function in older people with RA. Therefore, it is essential that older people with RA be provided with systematic foot health assessments, care and rehabilitation to promote their lower extremity health and improve their functional health. Multiprofessional collaboration and seamless care chains at different levels of health care could benefit older people with RA looking to maintain their functional ability and - above all - promote their active ageing.

Nursing and allied health workforce in Australian public rheumatology departments is inadequate: a cross-sectional observational study

Rheumatological conditions are complex and impact many facets of daily life. Management of people with rheumatological conditions can be optimised through multidisciplinary care. However, the current access to nursing and allied health professionals in Australia is unknown. A cross-sectional study of nursing and allied health professionals in Australian public rheumatology departments for adult and paediatric services was conducted. The heads of Australian public rheumatology departments were invited to report the health professionals working within their departments, referral pathways, and barriers to greater multidisciplinary care. A total of 27/39 (69.2%) of the hospitals responded. The most common health professionals within departments were nurses (n = 23; 85.2%) and physiotherapists (n = 10; 37.0%), followed by pharmacists (n = 5; 18.5%), psychologists (n = 4; 14.8%), and occupational therapists (n = 4; 14.8%). No podiatrists were employed within departments. Referral pathways were most common for physiotherapy (n = 20; 74.1%), followed by occupational therapy (n = 15; 55.5%), podiatry (n = 13; 48.1%), and psychology (n = 6; 22%). The mean full-time equivalent of nursing and allied health professionals per 100,000 population in Australia was 0.29. Funding was identified as the most common barrier. In Australia, publicly funded multidisciplinary care from nurses and allied health professionals in rheumatology departments is approximately 1.5 days per week on average. This level of multidisciplinary care is unlikely to meet the needs of rheumatology patients. Research is needed to determine the minimum staffing requirements of nursing and allied health professionals to provide optimal care.

Patients' perspectives on systemic sclerosis-related Raynaud's phenomenon in the feet: A qualitative study from the OMERACT Foot and Ankle Working Group

OBJECTIVE

To explore, from patients' perspectives, the symptoms and impact of Raynaud's phenomenon (RP) on the feet of patients with systemic sclerosis (SSc-RP), and to identify which foot-related domains are important to patients.

METHODS

Forty participants (34 women) with SSc-RP took part in one of six focus groups held in the United Kingdom or United States. Participants were purposively sampled to ensure diversity in disease type, duration, and ethnicity. The topic guide included questions on RP impact, self-management, and treatment expectations. Qualitative content analysis was employed to identify key concepts in the data relating to foot-specific symptoms and their impact. Themes were organized by corresponding domains of potential importance.

RESULTS

Twenty-eight participants (70 %) reported experiencing RP in their feet. Five themes were identified corresponding to domains of potential importance: temperature changes, pain, cramping and stiffness, numbness, and color changes. These issues negatively affected participants' lives, impairing walking, driving, and socializing, and causing issues with footwear and hosiery.

CONCLUSIONS

This large qualitative study exploring the experiences of patients with SSc-RP in the feet identified several key domains of high importance to patients. SSc-RP is common in the feet, presents in several patterns, and impacts multiple aspects of patients' lives. These findings indicate where future foot-specific interventions for RP could be targeted. Findings from this study improve understanding of what domains are important to patients with SSc-RP affecting the feet and will contribute to the development of a core outcome set for foot and ankle disorders in rheumatic and musculoskeletal diseases.

Epidemiology of osteoarthritis: literature update 2022-2023

PURPOSE OF REVIEW

This review highlights recently published studies on osteoarthritis (OA) epidemiology, including topics related to understudied populations and joints, imaging, and advancements in artificial intelligence (AI) methods.

RECENT FINDINGS

Contemporary research has improved our understanding of the burden of OA in typically understudied regions, including ethnic and racial minorities in high-income countries, the Middle East and North Africa (MENA) and Latin America. Efforts have also been made to explore the burden and risk factors in OA in previously understudied joints, such as the hand, foot, and ankle. Advancements in OA imaging techniques have occurred alongside the developments of AI methods aiming to predict disease phenotypes, progression, and outcomes.

SUMMARY

Continuing efforts to expand our knowledge around OA in understudied populations will allow for the creation of targeted and specific interventions and inform policy changes aimed at reducing disease burden in these groups. The burden and disability associated with OA is notable in understudied joints, warranting further research efforts that may lead to effective therapeutic options. AI methods show promising results of predicting OA phenotypes and progression, which also may encourage the creation of targeted disease modifying OA drugs (DMOADs).