Foot Involvement as the First Manifestation in Rheumatoid Arthritis

NewsBot · Aug 10, 2021

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Foot Involvement as the First Manifestation in Rheumatoid Arthritis Patients in Lahore
Sajid Ali Khan et al
Cureus. 2021 May 31;13(5):e15347

Objective The objective of this study was to determine the involvement of the foot as the first manifestation in rheumatoid arthritis (RA). Methods This study was conducted on 100 patients who presented to the outpatient department of the Rheumatology Department at Fatima Memorial Hospital and College of Medicine and Dentistry in Lahore, Pakistan. The period of this cross-sectional study was three months - from October 2017 to December 2017. One hundred patients aged more than 16 years, who were diagnosed as cases of RA with foot involvement, and with a disease duration of less than two years (to minimize recall bias), were enrolled for the study. Results Out of the 100 patients, 20% were male and 80% were female. The mean age of the study population was 41.16 ± 12.343 years. Foot Involvement as the first manifestation was noted in 29 (29%) of the cases. The pattern of foot involvement shows a 59% forefoot involvement, 27% hindfoot involvement, and 14% midfoot involvement. Walking difficulty was most common in forefoot involvement (71.42% of cases), followed by hindfoot involvement (20% of cases), and least common in midfoot involvement (8.57% of cases) (p=0.0001). Conclusion Foot involvement as the first manifestation is quite common in RA and should not be ignored, especially in patients with large joint involvement sparing the hands.
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NewsBot · Aug 10, 2021

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NewsBot · Dec 12, 2021

During development of rheumatoid arthritis, intermetatarsal bursitis may occur before clinical joint swelling: a large imaging study in patients with clinically suspect arthralgia
Bastiaan T van Dijk et al
Rheumatology (Oxford). 2021 Nov 13

Objectives: Intermetatarsal bursitis (IMB) represents juxta-articular synovial inflammation of the intermetatarsal bursae. Recent MRI-studies identified IMB as feature of early RA, but whether IMB already occurs in the pre-arthritic phase is unknown. We performed a large MRI-study in clinically suspect arthralgia (CSA) to assess the occurrence and prognostic value of IMB.

Methods: 577 consecutive CSA-patients underwent contrast-enhanced MRI of the forefoot, metacarpophalangeal joints and wrist. MRIs were evaluated for subclinical synovitis/tenosynovitis/osteitis in line with the RA MRI scoring system (summed as RAMRIS-inflammation) and for IMB. IMB was considered present if uncommon in the general population at the same location (i.e. size scored above the 95th-percentile in age-matched symptom-free controls). The relation of IMB with other MRI-detected subclinical inflammation synovitis/tenosynovitis/osteitis) was studied. Cox-regression assessed the association with clinical arthritis development during median 25 months follow-up. ACPA-stratification was performed.

Results: At presentation with CSA, 23% had IMB. IMB was more frequent in ACPA-positive than ACPA-negative CSA (47% vs 19%,p< 0.001). Patients with IMB were more likely to also have subclinical synovitis (OR 3.4 (95%CI 1.8-6.5)) and tenosynovitis (5.9(2.8-12.6)). IMB conferred higher risk of developing arthritis (HR 1.6(1.0-2.7) adjusted for other subclinical inflammation). IMB-presence predicted arthritis development in ACPA-positive CSA (adjusted HR 2.2(1.0-4.7)), but not in ACPA-negative CSA-patients (0.8(0.4-1.7)).

Conclusion: Approximately a quarter of CSA-patients have IMB, which is frequently accompanied by subclinical synovitis and tenosynovitis. IMB precedes development of clinical arthritis, particularly in ACPA-positive CSA. These results reinforce the notion that juxta-articular synovial inflammation is involved in the earliest phases of RA-development.
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NewsBot · Feb 7, 2022

Diagnostic and Therapeutic Challenge of Metatarsalgia in a Patient With Rheumatoid Arthritis
João N. Malta, Joana Martins, António Azenha, Pedro Lemos Pereira
Cureus 14(1): e21751. doi:10.7759/cureus.21751

A 63-year-old female patient, with a past history of rheumatoid arthritis, presented with insidious pain on the left foot second and third metatarsophalangeal joints, associated with swelling and morning stiffness (mean time: four hours). Physical examination evidenced a tender and soft nodularity in the third intermetatarsal space, along with sharp pain, consistent with Morton’s neuroma. Foot ultrasound suggested Morton’s neuroma, but not excluding the possibility of rheumatoid arthritis involvement. Foot magnetic resonance imaging suggested the possibility of extensive synovitis of the third metatarsophalangeal joint, but not excluding the coexistence of Morton’s neuroma because of the mass effect. Finally, the patient underwent an ultrasound-guided needle biopsy of the nodule, which confirmed metatarsophalangeal joint synovitis. The foot is a common location of rheumatoid arthritis manifestation, and metatarsophalangeal joint synovitis can mimic Morton’s neuroma. After a definite diagnosis, the patient recovered lower limb functional impairment after introducing adalimumab and a rehabilitation program. This case highlights the importance of an accurate differential diagnosis, pharmacological rheumatoid arthritis control, and physical medicine and rehabilitation programs to optimal clinical and functional improvement.
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NewsBot · Oct 21, 2022

The prevalence of foot health problems in people living with a rheumatic condition: a cross-sectional observational epidemiological study
Minna Stolt et al
Rheumatol Int. 2022 Oct 20

This study aimed to determine the prevalence of foot health problems in people living with any rheumatic condition and explore potential associations with exposure variables. A cross-sectional observational epidemiological design was applied. The participants were recruited from one regional patient association in southwest Finland. The data were collected in January-February 2019 and included the Self-reported Foot Health Assessment Instrument (S-FHAI) and demographic questions. In total, 495 responses were obtained. Overall, participants had many foot problems. The point prevalence of self-reported foot problems was 99 per 100 people living with a rheumatic condition. The most prevalent problems were foot pain (73%), dry soles (68%), thickened toenails (58%) and cold feet (57%). Lower educational attainment, increased amount of daily standing and accessing medical or nursing care for foot problems were associated with poorer foot health. The results reveal a high frequency of foot pain among people with rheumatic conditions. The study highlighted the importance of person-centred care and the biological focus that underpins and impacts foot health (what we understand, what we do, and our health-seeking behaviour). Interventions to promote biopsychosocial approaches to personalised foot care could advance people's readiness, knowledge and skill to care for their own feet.
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