The predictors of foot ulceration in patients with rheumatoid arthritis

Jill Firth, Robin Waxman, Graham Law, E Andrea Nelson, Philip Helliwell, Heidi Siddle, Simon Otter, Violet Butters, Lesley Baker, Rosemary Hryniw, Sarah Bradley, Lorraine Loughrey, Begonya Alcacer-Pitarch, Samantha Davies, Jennifer Tranter

Research output: Contribution to journalArticle

Abstract

This study was conducted to determine the predictors of foot ulceration occurring in patients with rheumatoid arthritis (RA) without diabetes. A multi-centre case control study was undertaken; participants were recruited from eight sites (UK). Cases were adults diagnosed with RA (without diabetes) and the presence of a validated foot ulcer, defined as a full thickness skin defect occurring in isolation on / below the midline of the malleoli and requiring > 14 days to heal. Controls met the same criteria but were ulcer naive. Clinical examination included loss of sensation (10g monofilament); ankle-brachial pressure index (ABPI); forefoot deformity (Platto); plantar pressures (PressureStat); RA disease activity (36 swollen/tender joint counts) and the presence of vasculitis. History taking included past ulceration/foot surgery; current medication and smoking status. Participants completed the Health Assessment Questionnaire (HAQ) and Foot Impact Scale. A total of 83 cases with 112 current ulcers and 190 ulcer naïve controls participated. Cases were significantly older (mean age 71 years; 95 % confidence interval [CI], 69-73 vs. 62 years, 60-64) and had longer RA disease duration (mean 22 years; 19-25 vs. 15, 13-17). Univariate analysis showed that risk of ulceration increases with loss of sensation; abnormality of ABPI and foot deformity. Plantar pressures and joint counts were not significant predictors. HAQ score and history of foot surgery were strongly associated with ulceration (odds ratio [OR] = 1.704, 95 % CI 1.274-2.280 and OR = 2.256, 95 % CI 1.294-3.932). Three cases and two controls presented with suspected cutaneous vasculitis. In logistic regression modelling, ABPI (OR = 0.04; 95 % CI, 0.01-0.28) forefoot deformity (OR = 1.14; 95 % CI, 1.08-1.21) and loss of sensation (OR = 1.22; 95 % CI, 1.10-1.36) predicted risk of ulceration. In patients with RA, ABPI, forefoot deformity and loss of sensation predict risk of ulceration but, in contrast with diabetes, raised plantar pressures do not predict risk.

Original languageEnglish
Pages (from-to)615-621
Number of pages7
JournalClinical Rheumatology
Volume33
Issue number5
Early online date6 Dec 2013
DOIs
Publication statusPublished - May 2014

Fingerprint

Foot
Ankle Brachial Index
Rheumatoid Arthritis
Confidence Intervals
Odds Ratio
Ulcer
Vasculitis
Pressure
Joints
Foot Ulcer
Foot Deformities
Skin
Health
Case-Control Studies
Logistic Models
Smoking
Surveys and Questionnaires

Keywords

  • Aged
  • Arthritis, Rheumatoid/complications
  • Case-Control Studies
  • Female
  • Foot Deformities/physiopathology
  • Foot Ulcer/complications
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pressure
  • Quality of Life
  • Recurrence
  • Surveys and Questionnaires
  • Time Factors
  • United Kingdom

Cite this

Firth, J., Waxman, R., Law, G., Nelson, E. A., Helliwell, P., Siddle, H., ... Tranter, J. (2014). The predictors of foot ulceration in patients with rheumatoid arthritis. Clinical Rheumatology, 33(5), 615-621. https://doi.org/10.1007/s10067-013-2428-7
Firth, Jill ; Waxman, Robin ; Law, Graham ; Nelson, E Andrea ; Helliwell, Philip ; Siddle, Heidi ; Otter, Simon ; Butters, Violet ; Baker, Lesley ; Hryniw, Rosemary ; Bradley, Sarah ; Loughrey, Lorraine ; Alcacer-Pitarch, Begonya ; Davies, Samantha ; Tranter, Jennifer. / The predictors of foot ulceration in patients with rheumatoid arthritis. In: Clinical Rheumatology. 2014 ; Vol. 33, No. 5. pp. 615-621.
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title = "The predictors of foot ulceration in patients with rheumatoid arthritis",
abstract = "This study was conducted to determine the predictors of foot ulceration occurring in patients with rheumatoid arthritis (RA) without diabetes. A multi-centre case control study was undertaken; participants were recruited from eight sites (UK). Cases were adults diagnosed with RA (without diabetes) and the presence of a validated foot ulcer, defined as a full thickness skin defect occurring in isolation on / below the midline of the malleoli and requiring > 14 days to heal. Controls met the same criteria but were ulcer naive. Clinical examination included loss of sensation (10g monofilament); ankle-brachial pressure index (ABPI); forefoot deformity (Platto); plantar pressures (PressureStat); RA disease activity (36 swollen/tender joint counts) and the presence of vasculitis. History taking included past ulceration/foot surgery; current medication and smoking status. Participants completed the Health Assessment Questionnaire (HAQ) and Foot Impact Scale. A total of 83 cases with 112 current ulcers and 190 ulcer na{\"i}ve controls participated. Cases were significantly older (mean age 71 years; 95 {\%} confidence interval [CI], 69-73 vs. 62 years, 60-64) and had longer RA disease duration (mean 22 years; 19-25 vs. 15, 13-17). Univariate analysis showed that risk of ulceration increases with loss of sensation; abnormality of ABPI and foot deformity. Plantar pressures and joint counts were not significant predictors. HAQ score and history of foot surgery were strongly associated with ulceration (odds ratio [OR] = 1.704, 95 {\%} CI 1.274-2.280 and OR = 2.256, 95 {\%} CI 1.294-3.932). Three cases and two controls presented with suspected cutaneous vasculitis. In logistic regression modelling, ABPI (OR = 0.04; 95 {\%} CI, 0.01-0.28) forefoot deformity (OR = 1.14; 95 {\%} CI, 1.08-1.21) and loss of sensation (OR = 1.22; 95 {\%} CI, 1.10-1.36) predicted risk of ulceration. In patients with RA, ABPI, forefoot deformity and loss of sensation predict risk of ulceration but, in contrast with diabetes, raised plantar pressures do not predict risk.",
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Firth, J, Waxman, R, Law, G, Nelson, EA, Helliwell, P, Siddle, H, Otter, S, Butters, V, Baker, L, Hryniw, R, Bradley, S, Loughrey, L, Alcacer-Pitarch, B, Davies, S & Tranter, J 2014, 'The predictors of foot ulceration in patients with rheumatoid arthritis', Clinical Rheumatology, vol. 33, no. 5, pp. 615-621. https://doi.org/10.1007/s10067-013-2428-7

The predictors of foot ulceration in patients with rheumatoid arthritis. / Firth, Jill; Waxman, Robin; Law, Graham; Nelson, E Andrea; Helliwell, Philip; Siddle, Heidi; Otter, Simon; Butters, Violet; Baker, Lesley; Hryniw, Rosemary; Bradley, Sarah; Loughrey, Lorraine; Alcacer-Pitarch, Begonya; Davies, Samantha; Tranter, Jennifer.

In: Clinical Rheumatology, Vol. 33, No. 5, 05.2014, p. 615-621.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The predictors of foot ulceration in patients with rheumatoid arthritis

AU - Firth, Jill

AU - Waxman, Robin

AU - Law, Graham

AU - Nelson, E Andrea

AU - Helliwell, Philip

AU - Siddle, Heidi

AU - Otter, Simon

AU - Butters, Violet

AU - Baker, Lesley

AU - Hryniw, Rosemary

AU - Bradley, Sarah

AU - Loughrey, Lorraine

AU - Alcacer-Pitarch, Begonya

AU - Davies, Samantha

AU - Tranter, Jennifer

N1 - Acceptance from webpage.

PY - 2014/5

Y1 - 2014/5

N2 - This study was conducted to determine the predictors of foot ulceration occurring in patients with rheumatoid arthritis (RA) without diabetes. A multi-centre case control study was undertaken; participants were recruited from eight sites (UK). Cases were adults diagnosed with RA (without diabetes) and the presence of a validated foot ulcer, defined as a full thickness skin defect occurring in isolation on / below the midline of the malleoli and requiring > 14 days to heal. Controls met the same criteria but were ulcer naive. Clinical examination included loss of sensation (10g monofilament); ankle-brachial pressure index (ABPI); forefoot deformity (Platto); plantar pressures (PressureStat); RA disease activity (36 swollen/tender joint counts) and the presence of vasculitis. History taking included past ulceration/foot surgery; current medication and smoking status. Participants completed the Health Assessment Questionnaire (HAQ) and Foot Impact Scale. A total of 83 cases with 112 current ulcers and 190 ulcer naïve controls participated. Cases were significantly older (mean age 71 years; 95 % confidence interval [CI], 69-73 vs. 62 years, 60-64) and had longer RA disease duration (mean 22 years; 19-25 vs. 15, 13-17). Univariate analysis showed that risk of ulceration increases with loss of sensation; abnormality of ABPI and foot deformity. Plantar pressures and joint counts were not significant predictors. HAQ score and history of foot surgery were strongly associated with ulceration (odds ratio [OR] = 1.704, 95 % CI 1.274-2.280 and OR = 2.256, 95 % CI 1.294-3.932). Three cases and two controls presented with suspected cutaneous vasculitis. In logistic regression modelling, ABPI (OR = 0.04; 95 % CI, 0.01-0.28) forefoot deformity (OR = 1.14; 95 % CI, 1.08-1.21) and loss of sensation (OR = 1.22; 95 % CI, 1.10-1.36) predicted risk of ulceration. In patients with RA, ABPI, forefoot deformity and loss of sensation predict risk of ulceration but, in contrast with diabetes, raised plantar pressures do not predict risk.

AB - This study was conducted to determine the predictors of foot ulceration occurring in patients with rheumatoid arthritis (RA) without diabetes. A multi-centre case control study was undertaken; participants were recruited from eight sites (UK). Cases were adults diagnosed with RA (without diabetes) and the presence of a validated foot ulcer, defined as a full thickness skin defect occurring in isolation on / below the midline of the malleoli and requiring > 14 days to heal. Controls met the same criteria but were ulcer naive. Clinical examination included loss of sensation (10g monofilament); ankle-brachial pressure index (ABPI); forefoot deformity (Platto); plantar pressures (PressureStat); RA disease activity (36 swollen/tender joint counts) and the presence of vasculitis. History taking included past ulceration/foot surgery; current medication and smoking status. Participants completed the Health Assessment Questionnaire (HAQ) and Foot Impact Scale. A total of 83 cases with 112 current ulcers and 190 ulcer naïve controls participated. Cases were significantly older (mean age 71 years; 95 % confidence interval [CI], 69-73 vs. 62 years, 60-64) and had longer RA disease duration (mean 22 years; 19-25 vs. 15, 13-17). Univariate analysis showed that risk of ulceration increases with loss of sensation; abnormality of ABPI and foot deformity. Plantar pressures and joint counts were not significant predictors. HAQ score and history of foot surgery were strongly associated with ulceration (odds ratio [OR] = 1.704, 95 % CI 1.274-2.280 and OR = 2.256, 95 % CI 1.294-3.932). Three cases and two controls presented with suspected cutaneous vasculitis. In logistic regression modelling, ABPI (OR = 0.04; 95 % CI, 0.01-0.28) forefoot deformity (OR = 1.14; 95 % CI, 1.08-1.21) and loss of sensation (OR = 1.22; 95 % CI, 1.10-1.36) predicted risk of ulceration. In patients with RA, ABPI, forefoot deformity and loss of sensation predict risk of ulceration but, in contrast with diabetes, raised plantar pressures do not predict risk.

KW - Aged

KW - Arthritis, Rheumatoid/complications

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KW - Female

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KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Pressure

KW - Quality of Life

KW - Recurrence

KW - Surveys and Questionnaires

KW - Time Factors

KW - United Kingdom

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Firth J, Waxman R, Law G, Nelson EA, Helliwell P, Siddle H et al. The predictors of foot ulceration in patients with rheumatoid arthritis. Clinical Rheumatology. 2014 May;33(5):615-621. https://doi.org/10.1007/s10067-013-2428-7