Background/Purpose: Foot and ankle involvement in patients with rheumatoid arthritis is a common yet often underexplored and underrecognized manifestation. This can negatively affect patients’ quality of life and functional capacity. We aimed to describe the effect of foot and ankle joint involvement on the quality of life in patients with rheumatoid arthritis.

Methods: An observational, cross-sectional study was conducted at a university hospital rheumatology and traumatology outpatient clinics. Patients >18 years with a diagnosis of rheumatoid arthritis (ACR/EULAR 2010) were included. Health-related quality of life concerning foot health was assessed using the Foot Health Status Questionnaire (FHSQ), with higher scores indicating a better result. The Foot Function Index (FFI) was used to measure the impact of the disease on foot function, higher scores indicate worse foot function. Pain was evaluated using a visual analog scale (VAS). To measure the involvement of the foot, x-rays of both feet were taken in three projections and evaluated by an unaffiliated radiologist. The modified Sharp/van der Heijde (vdH-S) was utilized to evaluate the radiological findings of the lower extremity joints, separating high and low scores with a cutoff point of 4. Descriptive analysis was performed. Mann-Whitney´s U test and Chi-Square test were applied as appropriate, with a p-value < 0.05 considered statistically significant.

Results: A total of 81 patients were included, of whom 77 (95.1%) were women, with a median age of 59 years (IQR: 51–65). At the time of evaluation, the majority of patients (n=43, 53.1%) were in remission. The most common comorbidity was obesity (n = 28, 34.6%), followed by osteoarthritis (n = 16, 19.8%). Additionally, 62.79% of participants described living a sedentary lifestyle. The mean body weight was 69.2 ± 15.5 kg, with a median BMI of 28.2 (IQR: 24–32).
Radiological findings revealed that 69 patients (85%) experienced some degree of lower extremity joint involvement. The median score of vdH-S was 4 (IQR: 2–20), with a median erosion subscale score of 2 (IQR: 0–4.5) and a median joint space narrowing subscale score of 3 (IQR: 2–16). Among patients with lower-extremity joint involvement, subluxations were observed in 63 cases (77.8%), while 38 patients (46.9%) had evidence of osteoporosis and subchondral cysts, and 12 patients (14.8%) presented with synovitis. Patients with a score in vdH-S > 4 points, had a higher number of erosions and space joint narrowing compared to patients with a score < 4 points (p= < 0.001). Patients with a score of vdH-S >4 points had a significantly higher prevalence of osteoporosis (62% vs. 22.6%) than those with a score < 4 points (p= < 0.001). Regarding the quality of life and foot functionality, there was no differences in the involvement of the foot and ankle (p= 0.631, p=0.560, respectively).

Conclusion: Most patients (85%) had radiologic findings in the lower extremity joints, with subluxations in 77.8% and osteoporosis and subchondral cysts in 46.9%. There was no significant difference between quality of life and foot functionality in patients with foot and ankle joint involvement compared to those without.

IQR: Interquartile range; SD: Standard Deviation; FHSQ: Foot Health Status Questionnaire; FFI: Foot Function Index; VAS: Visual Analog Scale; vdH-S: Sharp/van der Heijde.

IQR: Interquartile range; SD: Standard Deviation; FHSQ: Foot Health Status Questionnaire; FFI: Foot Function Index; VAS: Visual Analog Scale; vdH-S: Sharp/van der Heijde.; Involvement: > 4 points on the modified vdH-S method

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quality-of-life-in-patients-with-rheumatoid-arthritis-with-foot-and-ankle-involvement/