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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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Tominaga A, Ikari K, Yamada A, Yano K, Okazaki K. Outcomes of Joint-Preserving Surgery for Forefoot Deformities in Patients With Rheumatoid Arthritis. Foot Ankle Int 2024; 45:261-271. [PMID: 38327241 DOI: 10.1177/10711007241226898] [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] [Indexed: 02/09/2024]
Abstract
BACKGROUND With the advent of effective disease-modifying medications, the surgical treatment of forefoot deformities in patients with rheumatoid arthritis (RA) has evolved from joint-sacrificing to joint-preserving surgery. However, it is unclear whether joint-preserving surgery is effective for the full range of metatarsophalangeal joint involvement. Hence, this study investigated the postoperative outcomes of joint-preserving surgery for rheumatoid forefoot deformities with a wide range of joint destruction. METHODS This retrospective observational study included 68 feet from 68 patients with RA who underwent joint-preserving surgery for forefoot deformities between 2014 and 2020. The Larsen grade classification was used to assess the first metatarsophalangeal joint destruction and classify patients into 4 groups as follows: 0 and 1 (n = 14), 2 (n = 21), 3 (n = 19), and 4 and 5 (n = 14). The Self-Administered Foot and Ankle Evaluation Questionnaire (SAFE-Q) score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were determined before surgery and at the last follow-up visit. RESULTS The median observation duration was 40 (range, 24-78) months. SAFE-Q scores of all groups significantly improved in all subscales at the last observation, with no significant differences among the study groups. Radiographic evaluations of all groups revealed significant improvements in HVA and IMA after surgery, with no significant differences among the groups. CONCLUSION In patients using the surgical approaches described in this study, joint-preserving surgery for rheumatoid forefoot deformities led to satisfactory clinical and radiographic improvements, regardless of the severity of joint destruction. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Ayako Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | - Akifumi Yamada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Sandomirski A, Johanshon J, Lohmann C, Lietz J. [Total arthroplasty of the ankle joint : Limitations and potentials]. Z Rheumatol 2023; 82:852-858. [PMID: 37819406 DOI: 10.1007/s00393-023-01422-6] [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] [Accepted: 06/16/2023] [Indexed: 10/13/2023]
Abstract
Total arthroplasty of the ankle joint (TAA) has become an established treatment option for patients with advanced osteoarthritis of the ankle joint. A crucial factor for good long-term clinical results and standing times is careful patient selection, taking the indications, contraindications, and defined prognostic factors into account. Despite modern prosthetic designs, TAA remains a complex surgical procedure that requires precise surgical techniques in a specialized center. Various limitations exist, such as the implantation technique and experience of the surgeon and perioperative complications due to concomitant medications. Current research focuses on the optimization of implant designs, development of personalized surgical techniques, improvement of the long-term performance and minimization of perioperative complications. Future developments, such as the introduction of robot-assisted surgical systems and the integration of biological procedures are also discussed as technological perspectives.
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Affiliation(s)
- Alexander Sandomirski
- Orthopädische Universitätsklinik, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Jana Johanshon
- Orthopädische Universitätsklinik, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Christoph Lohmann
- Orthopädische Universitätsklinik, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Jan Lietz
- Orthopädische Universitätsklinik, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Fazaa A, Triki W, Ouenniche K, Sellami M, Miladi S, Souabni L, Kassab S, Chekili S, Abdelghani KB, Laatar A. Assessment of the functional impact of foot involvement in patients with rheumatoid arthritis. Foot (Edinb) 2022; 52:101907. [PMID: 36049267 DOI: 10.1016/j.foot.2022.101907] [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: 06/27/2021] [Revised: 10/21/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
AIM OF THE WORK We aimed to evaluate the impact of foot involvement in patients with rheumatoid arthritis (RA) using the functional foot index (FFI) and to identify predictive factors of the functional impact of foot abnormalities in RA patients. PATIENTS AND METHODS This was a cross-sectional study including patients with RA meeting the criteria of the American College of Rheumatology and the European League Against Rheumatism 2010. The main epidemiological data, results of podoscopic and clinical examination of the foot and ankle, biological tests and radiological findings were collected. The presence of foot pain was assessed by a visual analogic scale (0-10), and the functional impact of foot involvement was assessed based on the validated French version of the FFI. RESULTS Fifty RA patients with an average age of 59.3 ± 9.9 years [39-79] were included, and 80% of them had foot involvement. Foot pain was present in 32 patients (64%), most frequently situated in the forefoot (56%). The average FFI score was 33.67 ± 30.53 [0-92.67]. The following factors had a significant association with the FFI score: an occupation soliciting the feet (p = 0.001), disease duration (p = 0.033, r = 0,302), the Health Assessment Questionnaire (p = 0.0001, r = 0,480), body mass index (p = 0.0001, r = 0,654), the presence of podiatric abnormalities (p = 0.0001) and Visual Analog Scale foot pain (p = 0.0001, r = 0,854). A significant association was also found between the FFI score and the presence of a hallux valgus (p = 0.004), a spread of the forefoot (p = 0.029), a claw of the toes (p = 0.002), a triangular forefoot (p = 0.0001), a quintus varus (p = 0.002), flat feet (p = 0.0001) and a valgus of the hindfoot (p = 0.001). CONCLUSION Due to the high frequency of foot involvement and its significant functional impact, meticulous examination of the feet and assessment of their functional impact must be one of the parameters for monitoring the disease. Its impact on one's quality of life can be important. LEVEL OF CLINICAL EVIDENCE 4 (cohort studies, non experimental, observational studies).
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Affiliation(s)
- Alia Fazaa
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
| | - Wafa Triki
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rheumatology Department, Mohamed Kassab National Institute, La Manouba, Tunisia.
| | - Kmar Ouenniche
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
| | - Meriem Sellami
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
| | - Saoussen Miladi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
| | - Leila Souabni
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
| | - Selma Kassab
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
| | - Selma Chekili
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
| | - Kawther Ben Abdelghani
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia
| | - Ahmed Laatar
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
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CKS2 and S100A12: Two Novel Diagnostic Biomarkers for Rheumatoid Arthritis. DISEASE MARKERS 2022; 2022:2431976. [PMID: 35789606 PMCID: PMC9250429 DOI: 10.1155/2022/2431976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic systematicness autoimmunity disease with joint inflammation. RA etiology is still unknown. Early and exact diagnosing is still hard to reach. In the paper, we purposed to discover novel diagnosis biological marker for RA. Two open, usable gene expression profiles of human RA as well as controlled specimens (dataset GSE17755 as well as GSE93272) were downloaded from the GEO database. Differentially expressed genes (DEGs) were screened between 331 RA and 88 control samples. Functional enrichment analysis was applied to explore the possible function of DEGs. Expression levels as well as diagnosis values of biological marker in RA were further verified in our cohort by the use of RT-PCR and ROC assays. We identified 13 DEGs between RA samples and control samples. 13 DEGs were remarkably abundant in NF-kappa B signal pathway. Among the 13 DEGs, CKS2, S100A12, LY96, and ANXA3 exhibited a strong diagnostic ability in screening RA specimens from normal specimens using all AUC > 0.8. Moreover, we confirmed that the expression of CKS2 and S100A12 was distinctly upregulated in RA specimens contrasted to normal specimens. Overall, serum CKS2 and S100A12 could be used as novel diagnosis biological markers for RA patients.
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Gaino JZ, Bértolo MB, Nunes CS, Sachetto Z, Landim SF, Magalhães EDP. The Structural Index Score and its relation to foot function, disability and physical performance tests in rheumatoid arthritis (RA) - A cross-sectional study. Foot (Edinb) 2022; 51:101876. [PMID: 35462089 DOI: 10.1016/j.foot.2021.101876] [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: 05/05/2021] [Revised: 07/15/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the Structural Index Score (SIS) - a clinical foot deformity assessment index developed for RA, and to compare its results with foot function, disability and physical performance tests. METHODS In this cross-sectional study, 104 patients with foot pain were evaluated according to SIS score, subscales (Forefoot SIS and Rearfoot SIS) and items. Results were compared with the Foot Function Index (FFI), the Health Assessment Questionnaire Disability Index (using lower limbs items: LL-HAQ), and physical performance tests: Berg Balance Scale (BBS), the Timed Up and Go test (TUG) and the 5-Time Sit down-to-Stand up Test (SST5). RESULTS There was a weak correlation of SIS score with FFI and LL-HAQ. Rearfoot SIS was correlated with FFI, LL-HAQ and worse performance in BBS, TUG and SST5. Regarding Rearfoot SIS items, the ankle ROM was correlated to all studied outcomes, the calcaneus varus/valgus was correlated with FFI (total, pain and disability subscales) and the planus/cavus deformity with FFI-pain, HAQ-DI and LL-HAQ. Forefoot SIS did not correlate with any outcome measures. In relation to Forefoot SIS items, hallux valgus was associated with foot function (FFI-total, pain and disability subscales), the MTPs joints subluxation was correlated with FFI-disability subscale, and the 5th MTP exostosis was associated with FFI-pain. CONCLUSION SIS score was correlated to impaired foot function (FFI) and disability (LL-HAQ). Rearfoot SIS was correlated to worse performance on FFI, LL-HAQ, BBS, TUG and SST5. SIS score index can be a useful tool to evaluate the rheumatoid foot deformities, but a better graduation of foot deformities should add sensitivity to this method.
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Affiliation(s)
- Juliana Zonzini Gaino
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil.
| | - Manoel Barros Bértolo
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil
| | - Caroline Silva Nunes
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas - Unicamp, Campinas, SP, Brazil
| | - Zoraida Sachetto
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil
| | - Síbila Floriano Landim
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas - Unicamp, Campinas, SP, Brazil
| | - Eduardo de Paiva Magalhães
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil; Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas - Unicamp, Campinas, SP, Brazil
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Perez-Gurbindo I, Peñaranda YF, García ÁO, Alvarez-Mendez A. Evaluation of Pressure Pain Sensitivity in the Forefoot of Healthy Individuals. J Am Podiatr Med Assoc 2022; 112:20-175. [PMID: 36459123 DOI: 10.7547/20-175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The evaluation of musculoskeletal pain in podiatric medical practice is mainly based on anamnesis and manual examination. However, when manual palpation is performed, the digital pressure necessary to adequately explore the different structures of the foot is unknown. We evaluated the pressure pain threshold in forefoot structures to determine the intensity and duration of the stimulus as clinically relevant and representative. METHODS In a transversal analytical study of 15 healthy individuals, 16 forefoot points were explored with a handheld pressure palpometer calibrated to exert maximum pressing force of 1.0 or 2.0 kilogram-force (kgf) applied during 5 or 10 sec. The combinations of the different pressures and intervals were selected randomly. Participants had to self-rate the pressure pain sensitivity of each stimuli on a 100-mm horizontal line (0-100 numeric rating scale), setting the pain threshold to 50 (100 being pain as bad as it could be). Likewise, aftersensation and referred pain patterns were recorded. RESULTS All participants indicated painful stimuli at some of the 16 forefoot points studied in the experimental protocol when pressure was applied with the 2.0-kgf palpometer; 53.3% showed evidence of pain at any forefoot point when the 1.0-kgf palpometer was used. The odds of evoking a painful sensation are 9.8 times higher when using a 2.0-kgf palpometer versus a 1.0-kgf palpometer. In addition, referred sensations were observed with a significantly higher frequency when applying the 2.0-kgf palpometer. CONCLUSIONS Bone and soft structures show differences in pressure sensitivity, increasing significantly when applying higher pressure force. Soft structures, specifically intermetatarsal spaces, showed the lowest pain pressure thresholds. More research is needed to better understand pressure pain response.
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Affiliation(s)
- Ignacio Perez-Gurbindo
- *Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Yolanda Fuentes Peñaranda
- *Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Ángel Orejana García
- *Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Ana Alvarez-Mendez
- *Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Complutense University of Madrid, Madrid, Spain
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Kelly ES, Worsley PR, Bowen CJ, Cherry LS, Keenan BE, Edwards CJ, O'Brien N, King L, Dickinson AS. Predicting Forefoot-Orthosis Interactions in Rheumatoid Arthritis Using Computational Modelling. Front Bioeng Biotechnol 2022; 9:803725. [PMID: 35004656 PMCID: PMC8733946 DOI: 10.3389/fbioe.2021.803725] [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] [Received: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Foot orthoses are prescribed to reduce forefoot plantar pressures and pain in people with rheumatoid arthritis. Computational modelling can assess how the orthoses affect internal tissue stresses, but previous studies have focused on a single healthy individual. This study aimed to ascertain whether simplified forefoot models would produce differing biomechanical predictions at the orthotic interface between people with rheumatoid arthritis of varying severity, and in comparison to a healthy control. The forefoot models were developed from magnetic resonance data of 13 participants with rheumatoid arthritis and one healthy individual. Measurements of bony morphology and soft tissue thickness were taken to assess deformity. These were compared to model predictions (99th% shear strain and plantar pressure, max. pressure gradient, volume of soft tissue over 10% shear strain), alongside clinical data including body mass index and Leeds Foot Impact Scale–Impairment/Footwear score (LFIS-IF). The predicted pressure and shear strain for the healthy participant fell at the lower end of the rheumatoid models’ range. Medial first metatarsal head curvature moderately correlated to all model predicted outcomes (0.529 < r < 0.574, 0.040 < p < 0.063). BMI strongly correlated to all model predictions except pressure gradients (0.600 < r < 0.652, p < 0.05). There were no apparent relationships between model predictions and instances of bursae, erosion and synovial hypertrophy or LFIS-IF score. The forefoot models produced differing biomechanical predictions between a healthy individual and participants with rheumatoid arthritis, and between individuals with rheumatoid arthritis. Models capable of predicting subject specific biomechanical orthotic interactions could be used in the future to inform more personalised devices to protect skin and soft tissue health. While the model results did not clearly correlate with all clinical measures, there was a wide range in model predictions and morphological measures across the participants. Thus, the need for assessment of foot orthoses across a population, rather than for one individual, is clear.
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Affiliation(s)
- Emily S Kelly
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Peter R Worsley
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Catherine J Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Lindsey S Cherry
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Bethany E Keenan
- Cardiff School of Engineering and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Neil O'Brien
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Leonard King
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alex S Dickinson
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
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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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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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Khaled SAA, Mahmoud HFF. Platelet indices parameters in the new disease activity score of rheumatoid arthritis with ankle involvement: A comparative analytic study. PLoS One 2021; 16:e0257200. [PMID: 34529695 PMCID: PMC8445486 DOI: 10.1371/journal.pone.0257200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Platelet indices (PIs) are platelet parameters that are correlated with platelet activity. Despite being widely available, inexpensive, and feasible; their use in clinical settings is limited. Recently, we developed a new score (EgyDAS), which relies on PIs and assesses disease activity in rheumatoid arthritis (RA). OBJECTIVES This study explored the practicability and validity of EgyDAS in RA with ankle involvement, considering that ankle is neglected in the commonly used DAS28 score. METHODS This comparative case-control study included 2-groups of RA patients, group1 (control): without and group 2: with ankle involvement. RESULTS Ankle involvement in RA showed no gender or age differences, however, it was associated with higher platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet distribution width (PDW), visual analogue scale (VAS), tender joint count (TJC), and lower hemoglobin (Hb) and mean platelet volume (MPV). DAS28 categorized a higher proportion of patients to have high disease activity compared with EgyDAS; moreover, it did not detect those in remission in group 2 patients. Highly significant differences in the 2-scores were observed between the two groups. Further analyses revealed superiority of EgyDAS in assessing disease activity in group 2 patients. Finally, both scores were found correlated together in the study groups. CONCLUSIONS Over or underestimation of RA disease activity could occur when using DAS28. PIs were found correlated with ankle involvement in RA. PIs and EgyDAS are the best tools to assess disease activity in RA patients with ankle involvement. However, the study recommended the use of both scores together.
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Affiliation(s)
- Safaa A. A. Khaled
- Department of Internal Medicine, Clinical Haematology Unit, Assiut University Hospital/Unit of Bone Marrow Transplantation, South Egypt Cancer Institute, Faculty of Medicine, Assiut University, Egypt
| | - Hamdy F. F. Mahmoud
- Department of Statistics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States of America
- Department of Statistics, Mathematics and Insurance, Faculty of Commerce, Assiut University, Egypt
- * E-mail:
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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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Chean CS, Lingham A, Rathod-Mistry T, Thomas MJ, Marshall M, Menz HB, Roddy E. Identification of patterns of foot and ankle pain in the community: Cross-sectional findings from the clinical assessment study of the foot. Musculoskeletal Care 2020; 19:9-19. [PMID: 32996230 DOI: 10.1002/msc.1502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate patterns of foot and ankle pain locations and symptoms, socio-demographic and comorbid characteristics to examine whether there are distinct foot and ankle pain phenotypes. METHODS Adults aged ≥50 years registered with four general practices in North Staffordshire were mailed a Health Survey questionnaire. Participants reporting foot pain in the last month indicated foot pain location on a foot manikin. Foot and ankle pain patterns were investigated by latent class analysis. Associations between the classes with foot pain symptoms, socio-demographic and comorbid characteristics were assessed. RESULTS Four thousand four hundred fifty-five participants with complete foot pain and manikin data were included in this analysis (mean age 65 years [SD 9.8], 49% male). Of those with foot and ankle pain (n = 1356), 90% had pain in more than one region. Six distinct classes of foot and ankle pain were identified: no pain (71%), bilateral forefoot/midfoot pain (4%), bilateral hindfoot pain (5%), left forefoot/midfoot pain (8%), right forefoot/midfoot pain (5%) and bilateral widespread foot and ankle pain (6%). People with bilateral widespread foot and ankle pain were more likely to be female, obese, depressed, anxious, have/had a manual occupation, have comorbidities, lower SF-12 scores and greater foot-specific disability. Age did not differ between classes. CONCLUSIONS Six distinct classes of foot and ankle pain locations were identified, and those with bilateral widespread foot and ankle pain had distinct characteristics. Further investigation of these individuals is required to determine if they have poorer outcomes over time and whether they would benefit from earlier identification and treatment.
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Affiliation(s)
- Chung Shen Chean
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Aranghan Lingham
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,East Kent Hospitals NHS Trust, William Harvey Hospital, Ashford, UK
| | - Trishna Rathod-Mistry
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Martin J Thomas
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK
| | - Michelle Marshall
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Hylton B Menz
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK
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Kasai T, Momoyama G, Nagase Y, Yasui T, Tanaka S, Matsumoto T. Disease activity affects the recurrent deformities of the lesser toes after resection arthroplasty for rheumatoid forefoot deformity. Mod Rheumatol 2020; 31:365-372. [PMID: 32552188 DOI: 10.1080/14397595.2020.1783164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this study was to clarify the effect of disease activity on recurrent deformities after resection arthroplasty for forefoot deformities in patients with rheumatoid arthritis (RA). METHODS This study included 83 feet in 58 patients with RA who underwent resection arthroplasty of all metatarsal heads, with a minimum follow-up of 2 years. The patients' demographic characteristics, preoperative radiographic findings, and RA disease activity evaluated using the 28-joint disease activity score based on the erythrocyte sedimentation rate (determined preoperatively and at the final follow-up) were compared between feet with and without postoperative recurrent deformities of the toes. Recurrent deformities were assessed separately for the hallux and lesser toes. RESULTS Recurrence in the hallux and lesser toes occurred in 23 feet (27.7%) and 13 feet (15.7%), respectively. With respect to recurrent hallux deformity, only the preoperative severity of hallux deformity was associated with recurrence. On the other hand, postoperative deformity of the lesser toes was positively associated with disease activity alone and not with other preoperative factors. CONCLUSION Postoperative control of RA disease activity was associated with recurrent deformity of the lesser toes but not that of the hallux after resection arthroplasty of all metatarsals for rheumatoid forefoot deformities.
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Affiliation(s)
- Taro Kasai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Gen Momoyama
- Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Orthopaedic Surgery, Itakura Hospital, Chiba, Japan
| | - Yuichi Nagase
- Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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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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16
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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:jcm9010042. [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.)
- Correspondence:
| | - 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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Tootle K, Hollnagel J, Kinmon K. Surgical Treatment of Severe Hallux Abductovalgus With Dislocation of the First Metatarsophalangeal Joint: A Case Presentation and Surgical Technique. Foot Ankle Spec 2019; 12:281-285. [PMID: 30929459 DOI: 10.1177/1938640019835300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe hallux abductovalgus deformity with dislocation and contracture at the first metatarsophalangeal joint is difficult to manage, especially in the presence of concomitant, long-standing rheumatoid arthritis. This article highlights a novel surgical technique that may be used to successfully address this challenging condition while minimizing the likelihood of complications. Levels of Evidence: Level IV.
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Affiliation(s)
- Kevin Tootle
- Department of Podiatry, Bethesda Hospital East, Boynton Beach, Florida
| | | | - Kyle Kinmon
- Department of Podiatry, Bethesda Hospital East, Boynton Beach, Florida
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18
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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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Abstract
History A 99-year-old Chinese-Indonesian woman with a longstanding history of diabetes mellitus was admitted for chest infection and was incidentally found to have bilateral deformed feet. She was otherwise asymptomatic and could ambulate independently. Photographs and radiographs of the feet were obtained.
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Affiliation(s)
- Adeline Mei-Yen Yong
- From the National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074
| | - Paul A Tambyah
- From the National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074
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20
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Horita M, Nishida K, Hashizume K, Nasu Y, Saiga K, Nakahara R, Machida T, Ohashi H, Ozaki T. Outcomes of Resection and Joint-Preserving Arthroplasty for Forefoot Deformities for Rheumatoid Arthritis. Foot Ankle Int 2018; 39:292-299. [PMID: 29415557 DOI: 10.1177/1071100717743996] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated the clinical outcomes of resection and joint-preserving arthroplasty for forefoot deformities in patients with rheumatoid arthritis. METHODS Sixteen feet of 14 women (average age, 67.1 years; range, 53-82) underwent resection arthroplasty of the metatarsal head (resection group), and 18 feet of 15 women (average age, 61.3 years; range, 40-73) underwent a metatarsophalangeal joint-preserving procedure with shortening oblique metatarsal osteotomies of the lesser toes (joint preservation group). The mean disease duration in the resection and joint preservation groups was 23.6 and 19.1 years, and the average follow-up period was 37.3 and 33.5 months, respectively. The classification of Larsen was used to assess the severity of destruction of the metatarsophalangeal (MTP) joint. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) score and postoperative complications. RESULTS The number of preoperative radiographic destruction of the MTP joints (Larsen grade II, III, IV, and V) was 0, 29, 39, and 12 joints in the resection group and 13, 67, 9, and 1 joints in the joint preservation group. The mean JSSF score improved significantly from 61.3 to 83.9 points in the resection group ( P < .001) and from 62.2 to 90.8 points in the joint preservation group ( P < .001). In the resection group, recurrence of callosities and claw toe deformity was observed in 6 and 3 feet, respectively. In the joint-preserving group, recurrence of callosities and hammer toe deformity was observed in 1 foot each. CONCLUSION The resection arthroplasty and joint-preserving procedure showed satisfactory clinical outcomes. However, whether both procedures can maintain the good clinical results without the recurrence of forefoot deformity will require longer follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Masahiro Horita
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichiro Nishida
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenzo Hashizume
- 2 Department of Rehabilitation, Okayama Rosai Hospital, Okayama, Japan
| | - Yoshihisa Nasu
- 3 Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenta Saiga
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryuichi Nakahara
- 4 Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahiro Machida
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hideki Ohashi
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Matsumoto T, Maenohara Y, Chang SH, Hirose J, Juji T, Ito K, Tanaka S. Lateral collapse of the tarsal navicular in patients with rheumatoid arthritis: Implications for pes planovarus deformity. Mod Rheumatol 2017; 28:800-807. [PMID: 29251168 DOI: 10.1080/14397595.2017.1416905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES In patients with rheumatoid arthritis (RA), the talonavicular joint is commonly involved and midfoot collapse can lead to progressive flattening of the arch. Despite a general awareness of the important structural role of the talonavicular joint in rheumatoid foot disease, details of its destructive pattern have not been elucidated. METHODS We cross-sectionally investigated 176 RA patients (342 feet) and classified their feet into the following five groups according to radiographic findings: arthritis (RA changes with normal navicular shape), Müller-Weiss Disease (MWD) (collapse of the lateral aspect of the tarsal navicular), flat (flattened navicular), ankylosis (ankylosis of the talonavicular joint), and normal. We compared medical histories and radiographic measurements among all five groups. RESULTS The arthritis group comprised 91 feet, 36 in the MWD group, nine in the flat group, 12 in the ankylosis group, and 194 classified as normal. The MWD group demonstrated a trend towards pes planovarus deformity in contrast to pes planovalgus deformity in the arthritis group. Corticosteroid use and the mean daily dosage were the highest in the MWD group. CONCLUSIONS This report revealed a high prevalence of MWD-like changes to the navicular in RA patients and its association with pes planovarus deformity and corticosteroid usage.
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Affiliation(s)
- Takumi Matsumoto
- a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan.,b Department of Rheumatology , JCHO Yugawara Hospital , Kanagawa , Japan
| | - Yuji Maenohara
- a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Song Ho Chang
- a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Jun Hirose
- a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Takuo Juji
- b Department of Rheumatology , JCHO Yugawara Hospital , Kanagawa , Japan
| | - Katsumi Ito
- b Department of Rheumatology , JCHO Yugawara Hospital , Kanagawa , Japan.,c Department of Orthopaedic Surgery , Heisei Yokohama Hospital , Kanagawa , Japan
| | - Sakae Tanaka
- a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
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Andrade Fernandes de Mello R, Garcia Rondina R, Valim V, Santos Belisario S, Burgomeister Lourenço R, Francisco Batista E, Horst Duque R. Isolated atrophy of the abductor digiti quinti in patients with rheumatoid arthritis. Skeletal Radiol 2017; 46:1715-1720. [PMID: 28799033 DOI: 10.1007/s00256-017-2741-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/11/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aim to discuss the association of isolated atrophy of the abductor digiti quinti muscle in patients with rheumatoid arthritis as well as review the anatomy and imaging findings of this condition on MRI. MATERIALS AND METHODS A consecutive series of 55 patients diagnosed with rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria were recruited. MRI of the clinically dominant feet was performed using a 1.5-T scanner. RESULTS The study population was predominantly female (94.5%), and the age range was 31-79 years (mean 57.5 ± 11). A total of 55 ankles were examined by MRI, and 20 patients (36.3%), all females, showed abductor digiti quinti denervation signs. Seven patients demonstrated severe fatty atrophy of the abductor digiti quinti, corresponding to Goutallier grade 4, 2 patients showed moderate fatty atrophy (Goutallier grade 3), and the remaining 11 patients showed less than 50% fatty atrophy, corresponding to a Goutallier grade 2. Substantial agreement was found for both intra- and interobserver agreement regarding the Goutallier grading system. CONCLUSION Prevalence of signs of abductor digiti quinti denervation on MRI was high in the studied population, suggesting that rheumatoid arthritis may be associated with inferior calcaneal nerve compression.
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Affiliation(s)
| | - Ronaldo Garcia Rondina
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
| | - Valéria Valim
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
| | - Stéphano Santos Belisario
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
| | | | - Elton Francisco Batista
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
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Sharif K, Sharif A, Jumah F, Oskouian R, Tubbs RS. Rheumatoid arthritis in review: Clinical, anatomical, cellular and molecular points of view. Clin Anat 2017; 31:216-223. [PMID: 28833647 DOI: 10.1002/ca.22980] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/14/2017] [Indexed: 02/01/2023]
Abstract
Rheumatoid arthritis (RA) is the most common chronic autoimmune disease of the joints affecting close to 0.5-1.0% of the general population. Although the etiopathogenesis of RA remains elusive, the involvement of dendritic cells and type 17 T-helper cells appears to be pivotal in maintaining a state of chronic inflammation. RA is generally characterized by small joint involvement. A chronic inflammatory process leads to joint destruction and to tendon and ligament laxity and disintegration. These processes result in an imbalance of forces acting on the joints causing joint deformities including swan neck deformity, boutonniere deformity of the hands, flexion deformity of the wrist, lesser toe deformities, and others. In some instances, bony erosions subsequent to the RA disease process can result in life-threatening events including, for example, atlanto-axial subluxation, which can cause myelopathy and paralysis; and basilar invagination, which can cause brain stem injury and imminent death. Although less commonly involved, larger joints are not spared, as evidenced by the involvement of the elbow, hip, and shoulder joints in a sizable proportion of RA patients. The progression and prognosis of this disease entity are variable, guarded and dependent on the efficacy and response to treatment modalities employed. Inadequate management results in disease progression, which ultimately leads to joint erosion, destruction, deformities and substantial decrease in the functional quality of life. Clin. Anat. 31:216-223, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Kassem Sharif
- Department of Medicine 'B' Sheba Medical Center, Tel-Hashomer Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alaa Sharif
- Department of Medicine 'B' Sheba Medical Center, Tel-Hashomer Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Fareed Jumah
- Department of Neuroscience, an-Najah National University Hospital, Nablus, Palestine
| | | | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Grenada
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Ebina K, Hirao M, Takagi K, Ueno S, Morimoto T, Matsuoka H, Kitaguchi K, Iwahashi T, Hashimoto J, Yoshikawa H. Comparison of the effects of forefoot joint-preserving arthroplasty and resection-replacement arthroplasty on walking plantar pressure distribution and patient-based outcomes in patients with rheumatoid arthritis. PLoS One 2017; 12:e0183805. [PMID: 28850582 PMCID: PMC5574579 DOI: 10.1371/journal.pone.0183805] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/13/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this retrospective study is to clarify the difference in plantar pressure distribution during walking and related patient-based outcomes between forefoot joint-preserving arthroplasty and resection-replacement arthroplasty in patients with rheumatoid arthritis (RA). Methods Four groups of patients were recruited. Group1 included 22 feet of 11 healthy controls (age 48.6 years), Group2 included 36 feet of 28 RA patients with deformed non-operated feet (age 64.8 years, Disease activity score assessing 28 joints with CRP [DAS28-CRP] 2.3), Group3 included 27 feet of 20 RA patients with metatarsal head resection-replacement arthroplasty (age 60.7 years, post-operative duration 5.6 years, DAS28-CRP 2.4), and Group4 included 34 feet of 29 RA patients with metatarsophalangeal (MTP) joint-preserving arthroplasty (age 64.6 years, post-operative duration 3.2 years, DAS28-CRP 2.3). Patients were cross-sectionally examined by F-SCAN II to evaluate walking plantar pressure, and the self-administered foot evaluation questionnaire (SAFE-Q). Twenty joint-preserving arthroplasty feet were longitudinally examined at both pre- and post-operation. Results In the 1st MTP joint, Group4 showed higher pressure distribution (13.7%) than Group2 (8.0%) and Group3 (6.7%) (P<0.001). In the 2nd-3rd MTP joint, Group4 showed lower pressure distribution (9.0%) than Group2 (14.5%) (P<0.001) and Group3 (11.5%) (P<0.05). On longitudinal analysis, Group4 showed increased 1st MTP joint pressure (8.5% vs. 14.7%; P<0.001) and decreased 2nd-3rd MTP joint pressure (15.2% vs. 10.7%; P<0.01) distribution. In the SAFE-Q subscale scores, Group4 showed higher scores than Group3 in pain and pain-related scores (84.1 vs. 71.7; P<0.01) and in shoe-related scores (62.5 vs. 43.1; P<0.01). Conclusions Joint-preserving arthroplasty resulted in higher 1st MTP joint and lower 2nd-3rd MTP joint pressures than resection-replacement arthroplasty, which were associated with better patient-based outcomes.
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Affiliation(s)
- Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- * E-mail:
| | - Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keishi Takagi
- Department of Rehabilitation, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sachi Ueno
- Department of Rehabilitation, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tokimitsu Morimoto
- Department of Orthopaedic Surgery, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Hozo Matsuoka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuma Kitaguchi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Iwahashi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Jun Hashimoto
- Department of Rheumatology, National Hospital Organization, Osaka-Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Jeong HJ, Sohn IW, Kim D, Cho SK, Park SB, Sung IH, Sung YK. Impact of midfoot and Hindfoot involvement on functional disability in Korean patients with rheumatoid arthritis. BMC Musculoskelet Disord 2017; 18:365. [PMID: 28836966 PMCID: PMC5571626 DOI: 10.1186/s12891-017-1726-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Foot involvement in rheumatoid arthritis (RA) patients has been reported to severely affect functional capacity and quality of life. We aimed to determine the impact of midfoot and hindfoot involvement on functional disability in Korean patients with RA. Methods We evaluated the RA involvement and deformity of three regions of the foot (forefoot, midfoot and hindfoot) and ankle using conventional radiography in Korean patients with RA. We compared the clinical features between RA patients with and without foot or ankle involvement. Using multivariable logistic regression analyses, the impact of midfoot or hindfoot involvement on functional disability in RA patients was evaluated. Results Overall, 120 patients with a median age of 48.0 [interquartile range (IQR), 37–56] years and median disease duration of 58.0 (IQR, 10–89) months were included. The prevalence of foot or ankle RA involvement was 74 (61.7%). The number of patients with forefoot, midfoot, hindfoot and ankle involvement was 32 (43.2%), 24 (32.4%), 46 (62.2%) and 4 (5.4%), respectively. Compared to patients without foot or ankle involvement those with such involvement had greater disease activity and functional disability, more of them were treated with biologic agents, and they had a lower health-related quality of life. After adjusting for potential confounders, hindfoot involvement was associated with a higher degree of functional disability. However, walking difficulty was more associated with midfoot involvement rather than with involvement in other regions. Conclusions In Korean patients with RA, hindfoot involvement is associated with functional disability and midfoot involvement affects walking. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1726-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hye-Jin Jeong
- Department of Rheumatology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Il Woong Sohn
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Dam Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Si-Bog Park
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul, South Korea
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.
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Ebina K, Hirao M, Hashimoto J, Nampei A, Shi K, Tomita T, Futai K, Kunugiza Y, Noguchi T, Yoshikawa H. Comparison of a self-administered foot evaluation questionnaire (SAFE-Q) between joint-preserving arthroplasty and resection-replacement arthroplasty in forefoot surgery for patients with rheumatoid arthritis. Mod Rheumatol 2016; 27:795-800. [DOI: 10.1080/14397595.2016.1259968] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
| | - Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
| | - Jun Hashimoto
- Department of Rheumatology, National Hospital Organization, Osaka-Minami Medical Center, Kawachinagano-shi, Japan,
| | - Akihide Nampei
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka-Minami Medical Center, Kawachinagano-shi, Japan,
| | - Kenrin Shi
- Department of Rheumatology, Yukioka Hospital, Osaka, Japan,
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Japan, and
| | - Kazuma Futai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
| | - Yasuo Kunugiza
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization, Hoshigaoka Medical Center, Hirakata, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
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Hreha J, Krell ES, Bibbo C. Role of Recombinant Human Bone Morphogenetic Protein-2 on Hindfoot Arthrodesis. Foot Ankle Clin 2016; 21:793-802. [PMID: 27871412 DOI: 10.1016/j.fcl.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite advances in understanding bone healing physiology and surgical techniques, delayed union and nonunion still occur after the treatment of hindfoot arthrodesis. There is increasing appeal of bone morphogenetic proteins (BMPs) owing to the innate osteoinductive abilities of BMPs. Effective treatment with BMPs has been shown in animal studies. Human clinical studies have also shown success. The only study investigating the use of recombinant human BMP (rhBMP)-2 in hindfoot arthrodesis found a significant increase in fusion rate. Treatment cost effective. Complications from their use remain low. rhBMP-2 is a safe and effective bone-healing adjunct in hindfoot arthrodesis surgery.
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Affiliation(s)
- Jeremy Hreha
- Department of Orthopaedics, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA
| | - Ethan S Krell
- Department of Orthopaedics, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA
| | - Christopher Bibbo
- Department of Orthopaedics, The Rubin Institute for Advanced Orthopaedics at Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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Abstract
BACKGROUND Posterior tibial tendinopathy (PTT) is the most common cause of acquired (progressive) flatfoot deformity in adults. To date, PTT research has mainly focused on management rather than on causal mechanisms. The etiology of PTT is likely to be multifactorial because both intrinsic and extrinsic risk factors have been reported. We sought to critically evaluate reported etiologic factors for PTT and consider the concept of genetic risk factors. METHODS A detailed review of the literature published after 1936 was undertaken using English-language medical databases. RESULTS No clear consensus exists as to the relative importance of the risk factors reported, and neither has any consideration been given to a possible genetic basis for PTT. CONCLUSIONS To date, studies have examined various intrinsic and extrinsic risk factors implicated in the etiology of PTT. The interaction of these factors with an individual's genetic background may provide valuable data and help offer a more complete risk profile for PTT. A properly constructed genetic association study to determine the genetic basis of PTT would provide a novel and alternative approach to understanding this condition.
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Affiliation(s)
- Paul Beeson
- Division of Podiatry, The University of Northampton, Park Campus, Boughton Green Road, Northampton, Northamptonshire, NN2 7AL, England. (E-mail: )
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Matsumoto T, Nakada I, Juji T, Nakamura I, Ito K. Radiologic Patterning of Hallux Deformity in Rheumatoid Arthritis and Its Relationship to Flatfoot. J Foot Ankle Surg 2016; 55:948-54. [PMID: 27289217 DOI: 10.1053/j.jfas.2016.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Indexed: 02/03/2023]
Abstract
Hallux deformities other than hallux valgus, especially those in the sagittal plane, have not yet been elucidated in the feet of patients with rheumatoid arthritis. The objectives of the present study were to classify rheumatoid arthritis hallux deformity in both the horizontal and the sagittal planes and investigate its relationship with flatfoot. Using a cross-sectional study design, we assessed patients with rheumatoid arthritis (527 feet in 274 patients) using radiographs and classified the deformity patterns of the great toes using cluster analysis. Of the 274 patients, the range of motion in the metatarsophalangeal joint was clinically investigated in 44 (16.1%) patients. The great toes could be divided into 5 clusters according to the characteristic configuration as follows: cluster I (normal type), cluster II (hallux valgus type), cluster III (boutonniere type), cluster IV (boutonniere with hallux valgus type), and cluster V (swan-neck type). Radiographic measurements revealed the characteristic deformities of each cluster, including splayed foot for cluster II; flat foot, metatarsal primus elevatus, and plantar displacement of the proximal phalanx for cluster III; and a mixture of these characteristics for cluster IV. Plantar displacement of the proximal phalanx, which was a specific characteristic of the boutonniere deformity, correlated significantly with the decreased dorsiflexion in the metatarsophalangeal joint. Our classification method revealed the relationship of hallux deformity in the sagittal plane to flatfoot and also demonstrated the usefulness of measuring basal phalanx displacement in predicting the range of motion of the metatarsophalangeal joint.
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Affiliation(s)
- Takumi Matsumoto
- Assistant Professor, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
| | - Izumi Nakada
- Chief Physician, Department of Rheumatology, Yugawara Hospital, Ashigara-shimo, Japan
| | - Takuo Juji
- Department Director, Department of Rheumatology, Yugawara Hospital, Yugawara, Ashigara-shimo, Japan
| | - Ichiro Nakamura
- Professor, Faculty of Medical Science for Health, Teikyo Heisei University, Tokyo, Japan; Visiting Department Director, Department of Rheumatology, Yugawara Hospital, Kanagawa, Japan
| | - Katsumi Ito
- Assistant Director, Yugawara Hospital, Kanagawa, Japan
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Sawachika F, Uemura H, Katsuura-Kamano S, Yamaguchi M, Bahari T, Miki K, Todo S, Inoo M, Onishi I, Kurata N, Arisawa K. Changes in foot function, disease activity, and disability after forefoot resection arthroplasty in patients with rheumatoid arthritis. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:38-44. [PMID: 27040050 DOI: 10.2152/jmi.63.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The purpose of this study was to investigate the changes in foot function, disease activity, and disability in patients with RA after resection arthroplasty of the forefoot (arthroplasty). Arthroplasty was performed on 11 patients with RA. All study patients underwent clinical assessment to measure disease activity (Disease Activity Score in 28 Joints-C-reactive protein, DAS28-CRP), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI) and foot function (Foot Function Index, FFI) at the following stages: preoperatively and 1, 3, and 12 months after surgery. Following arthroplasty, foot function improved significantly, as assessed by FFI total and subscales (pain, disability, and limitation of activity) (P<0.001, P<0.001, P<0.001, and P=0.002, respectively). Disease activity was significantly improved in relation to DAS28-CRP and its subscales of number of swollen joints and patient global assessment (PtGA) (P=0.033, P=0.008, and P=0.038, respectively). There was no significant difference in disability, as assessed by the HAQ-DI and its subscale, HAQ-walking (P=0.150 and P=0.597, respectively). Foot function improved significantly after arthroplasty, and was maintained at 12 months postoperatively. Additionally, our study showed that disease activity and its subscale PtGA improved after arthroplasty.
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Affiliation(s)
- Fusakazu Sawachika
- Department of Preventive Medicine, Institute of Biomedical Sciences, the University of Tokushima Graduate School
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Nakada I, Nakamura I, Juji T, Ito K, Matsumoto T. Correlation between knee and hindfoot alignment in patients with rheumatoid arthritis: The effects of subtalar joint destruction. Mod Rheumatol 2015; 25:689-93. [DOI: 10.3109/14397595.2015.1008726] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nakasa T, Adachi N, Kato T, Ochi M. Distraction arthroplasty with arthroscopic microfracture in a patient with rheumatoid arthritis of the ankle joint. J Foot Ankle Surg 2015; 54:280-4. [PMID: 25619810 DOI: 10.1053/j.jfas.2014.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Indexed: 02/03/2023]
Abstract
We treated a 39-year-old female who had experienced destruction of her ankle joint owing to rheumatoid arthritis. This relatively young patient wished to avoid ankle fusion and joint replacement. Therefore, distraction arthroplasty with arthroscopic microfracture was performed to improve her symptoms and preserve motion. A microfracture procedure specifically for cartilage defects of the tibial plafond and talar dome was performed with the arthroscope, after which a hinged external fixator was applied to distract the ankle joint. The ankle joint space was enlarged by the external device and joint movement allowed. After 3 months, removal of the external device and repeat arthroscopy revealed newly formed fibrocartilage on the surfaces of both the tibia and the talus. At 2 years after the surgery, a radiograph showed that the joint space enlargement of the ankle had been maintained. The American Orthopaedic Foot and Ankle Society score improved from 37 points preoperatively to 82 points at 2 years postoperatively. Our findings suggest that good clinical results can be achieved with distraction arthroplasty and arthroscopic microfracture in a relatively young patient with rheumatoid arthritis.
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Orthopaedics Surgery, Integrated Health Sciences, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
| | - Nobuo Adachi
- Department of Orthopaedics Surgery, Integrated Health Sciences, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Tomohiro Kato
- Department of Orthopaedics Surgery, Integrated Health Sciences, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Mitsuo Ochi
- Department of Orthopaedics Surgery, Integrated Health Sciences, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
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The ankle and foot. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Matsumoto T, Nakamura I, Miura A, Momoyama G, Ito K. Radiologic patterning of joint damage to the foot in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2014; 66:499-507. [PMID: 24106167 DOI: 10.1002/acr.22174] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 09/10/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Foot and ankle deformities greatly affect the quality of life of rheumatoid arthritis (RA) patients. The aim of this study was to elucidate the pattern of destruction of the RA foot and its impact on patients. METHODS We cross-sectionally investigated RA patients (274 patients and 542 feet) using radiographs. The grade of joint destruction was assigned using Larsen's grading system for 12 joints in the foot and ankle. Cluster analysis was performed using the K-means method to classify the pattern of joint destruction. Of the 274 patients evaluated radiographically, 212 were assessed for functional disability using questionnaires. RESULTS Cluster analysis revealed that 542 feet were divided into 5 clusters, named according to the characteristic distribution of joint destruction: cluster I (normal type), cluster II (forefoot type), cluster III (midfoot type), cluster IV (mid-hindfoot type), and cluster V (combined type). Radiographic measurements revealed the characteristic deformities of each cluster: splay foot for cluster II, flat foot for cluster III, hindfoot malalignment for cluster IV, and mixtures of these characteristics for cluster V. A distribution map of each cluster based on disease duration revealed that cluster III peaked in cases of 5-10-year disease duration and subsequently decreased, followed by a gradual increase of cluster IV and cluster V. Cluster IV and cluster V showed significant changes in functional disability compared to cluster III. CONCLUSION This report is the first to reveal the pattern of RA foot deformities and their impact on patients using statistical measures in a large series.
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Costa MT, Backer RC, Ferreira RC. Avaliação clínico‐funcional da reconstrução do antepé nos pacientes portadores de artrite reumatoide. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Costa MT, Backer RC, Ferreira RC. Clinical and functional evaluation of forefoot reconstruction in patients with rheumatoid arthritis. Rev Bras Ortop 2014; 49:167-73. [PMID: 26229794 PMCID: PMC4511664 DOI: 10.1016/j.rboe.2014.03.020] [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: 11/23/2012] [Accepted: 07/12/2013] [Indexed: 11/10/2022] Open
Abstract
Objective to evaluate the long-term results from reconstruction of the forefoot in patients with rheumatoid arthritis who underwent arthrodesis of the metatarsophalangeal joint of the hallux, resection arthroplasty of the heads of the lateral metatarsals and correction of the deformities of the smaller toes through arthrodesis of the proximal interphalangeal joint or closed manipulation. Methods seventeen patients (27 feet) who underwent forefoot reconstruction surgery by means of arthrodesis of the first metatarsophalangeal joint, resection of the heads of the lateral metatarsals and correction of the deformities of the smaller toes, were studied retrospectively. The mean follow-up was 68 months (12–148 months); the mean age was 52 years (range: 20–75 months); and four patients were male and 13 were female. Results the results were classified as excellent in 17 feet, good in two, fair in four and poor in two. The mean score on the AOFAS scale was 70 points; 21 feet (78%) were found to be asymptomatic; and six feet (22%) presented some type of symptom. Three feet presented pseudarthrosis, and one of these successfully underwent revision of the arthrodesis. There was no significant difference in scoring on the AOFAS scale or in the consolidation rate, between using a plate and screws and using Kirschner wires for fixation of the arthrodesis. Conclusion arthrodesis of the first metatarsophalangeal joint with resection arthroplasty on the heads of the lateral metatarsals and correction of the deformities of the smaller toes, which was used in forefoot reconstruction in rheumatoid patients, showed good long-term results with a high satisfaction rate among the patients and clinical-functional improvement.
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Affiliation(s)
- Marco Túlio Costa
- Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Cardoso Backer
- Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Cardenuto Ferreira
- Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
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Yamaguchi S, Tanaka Y, Shinohara Y, Taniguchi A, Sasho T, Takahashi K, Takakura Y. Anatomy of hallux valgus in rheumatoid arthritis: radiographic analysis using a two-dimensional coordinate system. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0739-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Suzuki T, Tohda E, Ishihara K. Power Doppler ultrasonography of symptomatic rheumatoid arthritis ankles revealed a positive association between tenosynovitis and rheumatoid factor. Mod Rheumatol 2014. [DOI: 10.3109/s10165-009-0150-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chan PSJ, Kong KO. Natural history and imaging of subtalar and midfoot joint disease in rheumatoid arthritis. Int J Rheum Dis 2013; 16:14-8. [PMID: 23441767 DOI: 10.1111/1756-185x.12035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Foot involvement is not uncommon and occurs early in the disease course of rheumatoid arthritis (RA). Inflammation and ongoing synovitis of foot joints lead to joint destruction and instability, tendon dysfunction, and eventually collapse of the medial longitudinal arch and pes planovalgus that contributes to difficulty in walking and gait abnormalities. This article reviews foot-related problems in patients with RA, focusing on the prevalence, natural history and role of imaging in both diagnosis and management of midfoot and subtalar joint disease in RA.
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Waller R, Manuel P, Williamson L. The swindon foot and ankle questionnaire: is a picture worth a thousand words? ISRN RHEUMATOLOGY 2012; 2012:105479. [PMID: 23056959 PMCID: PMC3463932 DOI: 10.5402/2012/105479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 08/29/2012] [Indexed: 11/23/2022]
Abstract
Objectives. Despite increased awareness of the high prevalence and significance of foot and ankle problems in rheumatoid arthritis (RA), feet remain neglected. Reasons may include the perception that feet are difficult to assess, they are not included in the DAS28, and lack of freely available foot screening tools specific for RA. Methods. The Swindon Foot and Ankle Questionnaire (SFAQ) is a simply worded 10-point foot and ankle screening questionnaire with diagrams of feet and ankles for use in general rheumatology outpatients. All RA patients on our electronic database were invited to complete the questionnaire and attend clinic for assessment. Patients assessed clinically were scored out of 10 using the parameters from the questionnaire. The SFAQ was compared to the Manchester Foot Pain and Disability Index (MFPDI), DAS28, HAQ, HAD, and OSRA scores. Results. 597 questionnaires were sent, 301 (50%) returned, and 137 seen in clinic. There was good correlation between the postal SFAQ score, clinic score (r = 0.63), and the MFPDI (r = 0.65). Neither of the foot scores correlated with other RA disease outcome measures. 75% patients completed the picture. 73% corresponded to clinical findings. 45% of patients required an intervention following clinical review and trended towards higher scores. Conclusions. The SFAQ was quick to complete and correlated with the MFPDI. Lack of association with standard RA outcome measures suggests that relying on these scores alone may miss foot pathology. The diagrams were a useful complement. This simple screening tool could aid identification of RA foot and ankle problems.
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Affiliation(s)
- Rosemary Waller
- Department of Rheumatology, Great Western NHS Foundation Trust, Swindon SN3 6BB, UK
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Siddle HJ, Hodgson RJ, O'Connor P, Grainger AJ, Redmond AC, Wakefield RJ, Hensor EMA, Helliwell PS. Magnetic resonance arthrography of lesser metatarsophalangeal joints in patients with rheumatoid arthritis: relationship to clinical, biomechanical, and radiographic variables. J Rheumatol 2012; 39:1786-91. [PMID: 22859358 DOI: 10.3899/jrheum.120392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our exploratory study of painful lesser metatarsophalangeal (MTP) joints in patients with rheumatoid arthritis (RA) primarily aimed to compare the clinical, biomechanical, and plain radiography findings with magnetic resonance (MR) arthrography findings. Our secondary aim was to compare standard unenhanced MR with MR arthrography in imaging the lesser MTP joints in RA. METHODS In 15 patients with RA, the more symptomatic forefoot was imaged using 3T MR imaging. Proton density fat-suppressed images were acquired through the lesser MTP joints prior to arthrography. Under ultrasound guidance, contrast agent was injected into 2 lesser MTP joints. T1-weighted fat-suppressed sequences were subsequently acquired. The MR images were read by 2 musculoskeletal radiologists and consensus was reached. Spearman's correlation coefficient was used to assess the association between abnormalities seen on MR arthrography and the clinical, biomechanical, and plain radiography findings. RESULTS MR arthrography demonstrated pathology at 18 of 28 lesser MTP joints (64%) examined in patients with RA. MR arthrography abnormalities were associated with RA disease duration, forefoot deformity, Larsen score, subluxation, and peak plantar pressure. Unenhanced MR had a sensitivity of 78% and specificity of 90% for detecting pathology compared to MR arthrography. CONCLUSION Capsule and plantar plate pathology occurs in the painful forefoot of patients with RA and is associated with features of disease and deformity at the lesser MTP joints. Compared with MR arthrography, standard MR imaging was highly specific and moderately sensitive for diagnosing lesser MTP joint pathology in patients with RA.
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Affiliation(s)
- Heidi J Siddle
- Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, National Institute for Health Research Leeds Msculoskeletal Biomedical Research Unit, Department of Radiology, Leeds Teaching Hospitals National Health Service Trust, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
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De Mits S, Mielants H, De Clercq D, Woodburn J, Roosen P, Elewaut D. Quantitative assessment of foot structure in rheumatoid arthritis by a foot digitizer: detection of deformities even in the absence of erosions. Arthritis Care Res (Hoboken) 2012; 64:1641-8. [PMID: 22807070 DOI: 10.1002/acr.21794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Foot involvement is a major feature in rheumatoid arthritis (RA), leading to structural deformities. Methods to allow a 3-dimensional (3-D) evaluation of foot structure in RA to be applicable in daily clinical practice have not been evaluated. This study assessed the use of a foot digitizer, a noninvasive 3-D scanner collecting objective quantitative data of the feet, to evaluate the presence of foot structure abnormalities in an RA outpatient cohort. METHODS Foot digitizer data of RA patients were compared with healthy controls. Subanalyses were performed to find relationships with erosive disease and the presence of swollen and/or tender joints. Linear mixed models were applied with correction, including sex, age, body weight and height, foot length, Disease Activity Score in 28 joints, and disease duration. RESULTS Forty-one percent of the patients showed >1 abnormal parameter, measured with the 3-D foot scanner. Most differences found were located in the forefoot, the most frequently affected area of the RA foot. Strikingly, even in the absence of joint erosions, marked alterations were found. Comparable differences were also observed between the patients with and without swollen and/or tender joints. Additionally, alterations were not strongly related to foot pain and disability, suggesting the capacity of the foot digitizer to detect early changes in foot structure. CONCLUSION The results highlight the impact of RA on foot structure, even in the absence of clinical signs of swelling or radiographic erosions. The foot digitizer offers a valuable tool to screen for such foot deformities before the presence of erosions.
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Loveday DT, Jackson GE, Geary NPJ. The rheumatoid foot and ankle: current evidence. Foot Ankle Surg 2012; 18:94-102. [PMID: 22443994 DOI: 10.1016/j.fas.2011.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/19/2011] [Accepted: 06/30/2011] [Indexed: 02/04/2023]
Abstract
The management of rheumatoid patients is a complex process due to the chronic, systemic, multi-joint and extra-articular nature of the disease. In comparison, osteoarthritis and post-traumatic arthritis usually involve a single joint and are hence not comparable to rheumatoid pathology. This review sets out to specifically look at studies on rheumatoid patients with interventions for foot or ankle disease. MEDLINE, EMBASE, the Cochrane databases, Current Controlled Trials and the WHO International Clinical Trials Registry Platform are all searched for relevant studies.
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Affiliation(s)
- David T Loveday
- Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral CH49 5PE, United Kingdom.
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Recurrent peroneal tenosynovitis associated with inflammatory arthritis. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e318246dc07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Rheumatoid arthritis is a systemic disease that often affects the foot and ankle (85%-100% of patients). There are characteristic deformities in relation to the stage of disease. Clinical assessment of both lower limbs is important, since factors such as valgus deformity of the knee can cause malposition of the foot and ankle. In the early stages, patients present with joint effusion which causes destruction of the cartilage ("stiff type") and distends ligaments and capsules ("loose type"). Medial and lateral ankle tendons are destroyed and become insufficient. A reduction in walking distance, pain, instability and difficulties with footwear lead to reduced quality of life. The talonavicular joint and rheumatoid forefoot destruction are in most cases the central problem in the foot deformity. Adequate medical therapy of the rheumatic disease is mandatory. Conservative treatment such as orthotic shoe devices should be used in the early stages and are concomitantly used after surgical treatment. Rheumatoid arthritis is a systemic disease requiring careful, stage-specific perioperative management.
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Affiliation(s)
- O Niggemeyer
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg Eppendorf, Hamburg.
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Park DS, Hwang JH, Chang HJ, Koh EM. A Comparison of Gait Function and Regionalized Foot Pressure According to the Primary Symptomatic Foot Area of Patients with Rheumatoid Foot. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Ji Hye Hwang
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyun Jung Chang
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | - Eun Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Burke NG, Moran C, Din R, Walsh J, Quinlan WR. An unusual cause of pain post ankle arthrodesis in patients with rheumatoid arthritis. Foot (Edinb) 2010; 20:81-4. [PMID: 20452762 DOI: 10.1016/j.foot.2010.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 04/09/2010] [Accepted: 04/12/2010] [Indexed: 02/04/2023]
Abstract
Rheumatoid arthritis is an autoimmune disease which frequently affects the ankle and foot. End stage ankle arthritis from rheumatic disease is commonly managed by the established practice of ankle arthrodesis. Among the adverse sequelae causing pain following this surgery is infection, pseudo-arthrosis and non-union. Stress fracture of the distal third is a recognised but unusual cause of pain of tibia following ankle arthrodesis. The authors' present three patients with rheumatoid arthritis who sustained a stress fracture of the distal tibia following arthrodesis, and discuss the contributing factors and highlight the need for orthopaedic surgeons to be suspicious of this complication post surgery.
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Affiliation(s)
- Neil G Burke
- Department of Orthopaedic Surgery, St Vincent's University Hospital, Dublin, Ireland.
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Göksel Karatepe A, Günaydin R, Adibelli ZH, Kaya T, Duruöz E. Foot deformities in patients with rheumatoid arthritis: the relationship with foot functions. Int J Rheum Dis 2010; 13:158-63. [PMID: 20536601 DOI: 10.1111/j.1756-185x.2010.01465.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to investigate foot deformities in patients with rheumatoid arthritis (RA), to detect frequency of deformities and to assess the relationship between foot deformities and foot functions. METHODS Anteroposterior and lateral radiographs of 40 patients and 40 control subjects were studied. The hallux valgus (HV) angle, intermetatarsal angle between first and second metatarsals, intermetatarsal angle between first and fifth metatarsals, and calcaneal pitch were measured on radiographs. Foot functions were measured by the Foot and Ankle Outcome Score (FAOS). RESULTS The frequency of foot deformities in RA patients was determined as 78.8%. The most frequent foot deformity in RA patients was HV (62.5%), followed by metatarsus primus varus (MPV) (41.3%). MPV and splaying of the forefoot deformities were significantly more frequent in RA patients than the control group (P < 0.05). Mild to moderate effect on FAOS subscales was observed in RA patients. There was a slight, but significant correlation between the foot deformities and the FAOS subscales except for quality of life subscale. CONCLUSIONS In this study, it has been shown that foot deformities are frequent in patients with RA and that there is slight deterioration in foot functions related to RA. Our results indicated that foot deformities have small, but clinically important changes on foot functions. There is a need for more studies, which evaluates the foot deformities, to further explore the relationship between the foot deformities and foot function in patients with RA.
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Affiliation(s)
- Altinay Göksel Karatepe
- Izmir Bozyaka Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Izmir, Turkey.
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Carl HD, Gelse K, Swoboda B. Der rheumatische Fuß als Focus bakterieller Infektionen. Z Rheumatol 2010; 69:550-6. [DOI: 10.1007/s00393-010-0665-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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