Rheumatoid Necroses of the Forefoot Are Highly Underestimated

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Rheumatoid Necroses of the Forefoot Are Highly Underestimated

05/28/2004

By Shane

Rheumatoid necroses (RN), the incidence of which is highly underestimated,

can be the cause of foot deformation and destruction in patients with

rheumatoid arthritis, according to a recent study.

To determine the extent of RN, Irina Berger, MD, Institute of Pathology,

Heidelberg University, Heidelberg, Germany, and colleagues, examined biopsy

tissue from the feet of 223 patients who were seropositive for rheumatoid

arthritis (RA). The tissue was obtained during synovectomies in 104 cases

and forefoot resection in 119 cases.

The activity of RA disease was evaluated clinically from joint inspection

and mobility. White blood cell count and C-reactive protein levels were

noted and contributed to the disease activity evaluation.

RN was identified in 65% of patients. In 64.8% of the cases, RN came from

the joint capsule and 32.4% came from subcutaneous tissue. In 2.8%, RN were

located in both joint capsule and subcutaneous tissue.

Twenty one percent of the patients with RN had been diagnosed with RA for a

period of 5 to 10 years, 55% for 11 to 20 years, 16% for 21 to 30 years, and

8% for 31 years or more.

Rheumatoid necroses were found in 56.4% of patients with a disease duration

of 0 to 10 years, in 74% of patients with a disease duration of 11 to 20

years, in 57% of patients with a disease duration of 21 to 30 years, and in

55% of those with a disease duration of 31 years or more. Pain was reported

by 69% of patients.

Analysis of the data showed that rheumatoid necroses lesions are present in

RA patients independently from pain or disease activity. In such patients,

foot deformation was the indication for surgical intervention.

" The frequency of rheumatoid necrosis shows that it should be counted among

the important morphological criteria of RA of the foot, " say the

researchers.

Foot Ankle Int 2004 May;25:5:336-9