Rheumatoid arthritis (RA) is often a result of foot involvement which is part of the well-described clinical picture. It has been estimated, with no formal survey and in a random selection of geographically defined RA population, that patients with a longstanding RA get around 30% to 90% foot involvement.
It is common to find clinical issues involving the feet including articular features such as joint pain, stiffness, and swelling, extra-articular features such as bursae, nodules, and numbness, structural deformities such as hallux valgus and toe deformities and cutaneous lesions such as callosities, nail pathologies, and ulceration. In the meantime, foot problems can lead to reduced walking distance, impaired health-related quality of life and an increased risk of falls. The prospective longitudinal studies report that patients have been classified as being in remission, up to 40% have continuing disease features in the feet.
National guidelines and expert opinion call for timely and appropriate foot care which has been reported to be poor. The non-pharmalogical management of foot problems in patients with RA can involve a variety of interventions such as treatment of cutaneous lesions, provision of foot orthoses, prescribed footwear and orthopedic surgery.
A study published by BioMed Central, shows the evidence base quantifying the prevalence of foot problems and access to foot care in patients with RA has uncertainty, as it rests on observational hospital-based studies using convenience sampling strategies or surveys of self-selecting groups using restricted outcome measures. These studies have provided valuable insights so that their finding cannot be extrapolated to the general RA population. They may not account for regional variation of foot care provision for patients with RA and the clinical data has not been documented in detail.
A survey is required in order to access a large group of foot care in patients with RA, randomly selected from a defined population which has equitable access to both primary and secondary based foot care services and including assessment of the full range of impact.
This survey will be important to report an assessment using a RA population-based sample in a well-defined geographical area to determine the prevalence of self-reported foot problems, assess their impact, identify the proportion of patients who have accessed foot care within the study geographical area.
A study conducted in Bristol concluded that foot problems were present in 91% of a random sample all of adult patients with RA and they substantially impacted on patient’s lives. Overall access to foot care was higher than anticipated and clinicians need to have the clinical expertise in foot assessments and knowledgeable of the clinical management of foot problems.
Check the full study here.