Background: Foot symptoms in RA derive from a combination of inflammation, altered foot mechanics, deformity and secondary skin lesions. Guidelines recommend regular review of patients' feet, the extent to which the general population of RA patients report foot symptoms and access foot care has not been established. Methods: All RA patients under hospital care in a defined geographical area (Bristol Community Health) were identified from relevant departmental records. A random sample was sent a postal survey (reminder after 3 weeks) about presence of symptoms, disability (HAQ) and patient characteristics (age, disease duration, arthritis medication and co-morbidities). Measures of impact [Foot Impact Scale (FIS)] with additional questions (numerical rating scales) related to importance, severity, coping and ability to work derived from a previous study. For each patient an Indices of Multiple Deprivation (IMD) score (a measure of socio-economic status) was derived from postcodes. Results: Of 739 patients sent the survey, 413 (56%) replied. Responders and non-responders were similar for age (63.5 vs 61.5 years), gender (74.1%F vs 75.2%F) and socio-economic status (IMD highest deprivation quintiles 13.3% vs 15.9%). Responders' median (inter-quartile range) disease duration was 10 (5-20) years and HAQ score 1.5 (0.75-2.0). Most responders (394, 95.4 %) were taking arthritis medication and 273 (66.1%) reported additional medical conditions (including 28 (6.8%) with diabetes). Almost all (377) reported current foot symptoms (91.3%) or previous foot symptoms (6.3%), 10 (2.4%) reported never having foot symptoms. Current symptoms included: articular features 73.8%; extra articular features 42.6%; cutaneous lesions 65.4%; structural deformity 57.6%; infection 7.5%. Median (IQR) FIS impairment footwear score 10/21 (6-14); and FIS activities participation score 16/30 (7-23). Median (IQR): importance was 6 (3-8); severity 6 (3-8); and coping 5 (3-7). Overall, 37.8% reported that foot symptoms affected their ability to work. Of respondents, 69.5% had accessed foot care. This was similar for men and women (62.3%M vs 72.0%F) (chi test P=0.80, NS), as were the proportions who accessed podiatry (42.1%M vs 52.0%F), orthotics (39.3%M vs49.2%F) and orthopaedics (15.0%M vs 24.8%F). There was no difference in foot care access in relation to socio-economic status. Conclusion: Unlike previous studies this was representative of all hospital patients with RA and almost all reported foot symptoms. Although FIS scores were slightly lower than in previous studies based on patients recruited at hospital or foot care clinic appointments, nevertheless substantial impact was reported including affecting ability to work. In spite of this, 30% of patients had never accessed foot care. Further research is required to compare self-report of foot symptoms with clinical observations and explore the reasons why patients do and do not access foot care. (Table presented).
- rheumatoid arthritis
- foot problems