RESEARCH - The prevalence of foot ulceration in patients with RA

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Arthritis Rheum. 2008 Jan 31;59(2):200-205 [Epub ahead of print]

The prevalence of foot ulceration in patients with rheumatoid arthritis.

Firth J, Hale C, Helliwell P, Hill J, EA.

University of Leeds, Leeds, UK.

OBJECTIVE: To establish the prevalence of foot ulceration in patients

with rheumatoid arthritis (RA) in secondary care. METHODS: A postal

survey of all patients with RA (n = 1,130) under the care of

rheumatologists in Bradford, West Yorkshire, UK was performed. The

prevalence data were validated through clinical examination, case-note

review, and contact with health professionals. The false-negative rate

was investigated in a subsample of patients (n = 70) who denied any

history of ulceration. RESULTS: The postal survey achieved a 78%

response rate. Following validation, the point prevalence of foot

ulceration was 3.39% and the overall prevalence was 9.73%. The

false-positive rate was initially high at 21.21%, but use of

diagrammatic questionnaire data to exclude leg ulceration reduced the

rate to 10.76%. The false-negative rate was 11.76%. The most common

sites for ulceration were the dorsal aspect of hammer toes, the

metatarsal heads, and the metatarsophalangeal joint in patients with

hallux abducto valgus, with 33% of patients reporting multiple sites

of ulceration. Patients with open-foot and healed-foot ulceration had

significantly longer RA disease duration, reported significantly

greater use of special footwear, and had a higher prevalence of foot

surgery than ulcer-free patients. CONCLUSION: Foot ulceration affects

a significant proportion of patients with RA. Further work is needed

to establish risk factors for foot ulceration in RA and to target foot

health provision more effectively.

PMID: 18240257

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=182402\

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