RESEARCH - Foot ulceration common in RA patients

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Foot Ulceration Common in Rheumatoid Arthritis Patients

By Will Boggs, MD

NEW YORK (Reuters Health) Mar 10 - Patients with rheumatoid arthritis

(RA) often develop foot ulcers, according to a report in the February

15th issue of Arthritis & Rheumatism.

" Foot ulceration affects 1 in 10 patients with RA and is often a

recurrent problem affecting multiple sites in the foot, " Dr. Jill

Firth from the University of Leeds, UK told Reuters Health. " Clinical

examination should include looking for early signs of tissue damage

and intervening before ulceration occurs. "

Dr. Firth and colleagues investigated the prevalence of foot

ulceration in patients with RA under the care of rheumatologists.

Based on validated self-reports after exclusion of patients with

coexistent diabetes, the point prevalence of foot ulceration in RA

patients is 3.39%, and the overall prevalence is 9.73%, the

investigators report.

One-third of the patients with ulcers reported multiple sites of

ulceration, the team found, with the most common ulceration sites

being the dorsal aspect of hammer toes (48%), metatarsal heads (32%),

and the medial aspect of the first metatarsophalangeal joint in

patients with associated hallux abducto valgus (20%).

Nearly half the patients with ulcerations reported multiple episodes,

ranging from 2 to 30 episodes, the researchers note.

Open and healed foot ulceration was associated with significantly

longer disease duration, significantly greater usage of special

footwear, and a higher prevalence of foot surgery.

" The aim of the prevalence study was to establish the size of the

problem and to draw attention to the fact that this is an area which

has received little clinical or research attention, " Dr. Firth

explained. " The next step is to identify risk factors and to establish

appropriate screening techniques and care pathways to provide

evidence-based intervention. "

Meanwhile, " Podiatry involvement and assessment of footwear fit are

important considerations for clinicians, " Dr. Firth advised. " Close

attention should be paid to patients on anti-TNF therapies, as soft

tissue infection in an ulcer site may rapidly lead to life-threatening

sepsis if untreated. "

" Patients with connective tissue diseases, such as scleroderma, are

also at increased risk of foot ulceration associated with Raynaud's

and vasculitis, which can progress rapidly and requires specialist

multidisciplinary management, " Dr. Firth added.

Arthritis Rheum 2008;59:200-205.

http://www.medscape.com/viewarticle/571206

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