RESEARCH - The predictors of foot ulceration in patients with RA

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Clin Rheumatol. 2008 Nov;27(11):1423-8. Epub 2008 Jun 10.

The predictors of foot ulceration in patients with rheumatoid

arthritis: a preliminary investigation.Firth J, Helliwell P, Hale C,

Hill J, EA.

Postgraduate Suite, School of Healthcare, Baines Wing, University of

Leeds, Leeds, LS2 9JT, UK,

We explored the predictors of foot ulceration in patients with

rheumatoid arthritis (RA). The cases were 15 patients with RA

reporting foot ulceration in response to a postal survey of patients

sampled from a diagnostic register in secondary care (n = 1,130). The

controls were 66 patients with RA randomly sampled from the survey

respondents (n = 883) after matching for age, sex and disease

duration. Patients with co-existent diabetes were excluded. Clinical

examination included the assessment of known risk factors for foot

ulceration in diabetes including: neuropathy (insensitivity to 10 g

monofilament), peripheral vascular disease (ankle brachial pressure

index [ABPI]), foot deformity (Platto indices) and raised plantar

pressure (PressureStattrade mark readings). A 44 swollen-joint count,

the presence of pre-ulcerative lesions and current steroid therapy

were identified through univariate analysis as additional potential

predictors in patients with RA. Forward step-wise logistic regression

analysis showed that the following variables were significant

predictors of ulceration: steroid therapy (OR = 9.70, 95%CI =

2.09-45.11, p = 0.004), abnormal ABPI (OR = 13.45, 95%CI =

1.19-151.43, p = 0.035), the presence of pre-ulcerative lesions (OR =

7.40, 95%CI = 1.51-36.30, p = 0.014) and swollen-joint count (OR =

1.25, 95%CI = 1.02-1.53, p = 0.034). Abnormal sensation, foot

deformity and raised plantar pressures were not significant predictors

of ulceration. The wide confidence intervals for ABPI were due to

sparse data with very few abnormal values, and the results of exact

logistic regression (more accurate where data is sparse and case

matching employed) found that ABPI was no longer a significant

predictor (p = 0.054). The significance of the other predictors did

not differ substantially. In this preliminary study, abnormal

sensation, foot deformity and raised plantar pressures were not

significantly associated with foot ulceration but active disease and

current steroid therapy were. The contribution of peripheral vascular

disease to risk is unclear and further investigation is needed in a

larger cohort.

PMID: 18543055

http://www.ncbi.nlm.nih.gov/pubmed/18543055

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