Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Foot deformities frequently arise in patients with rheumatoid arthritis (RA). It might cause gait dysfunction and lead to disability. However, the precise mechanism of progression of foot deformity is still unclear. The aim of this study is to clarify the relationship between disease progression and the deformity of feet in patients with RA.
Methods:
The prospective cohort TOMORROW (TOtal Management Of Risk factors in Rheumatoid arthritis patients to lOWer morbidity and mortality; clinical trial registration number, UMIN000003876) study was started in 2010. We examined antero-posterior and lateral radiographs obtained from 416 weight-bearing feet of 208 patients with RA from this cohort. The stage of articular destruction was classified from the hand radiographs based on Steinbrocker’s classification. We measured the hallux valgus angle (HVA), the intermetatarsal angle between the first and second metatarsals (M1M2) and the first and fifth metatarsals (M1M5) on antero-posterior radiographs, and calcaneal pitch (CP) on lateral radiographs. Each deformity was defined as hallux valgus : HVA>15 degree, spread foot: M1M5>30 degree and flat foot :CP<20 degree.
Results:
We finally analyzed 387 feet of 196 patients excluding those that had been surgically treated. The mean age and mean disease duration were 58.2 years old and 12.7 years, respectively. Steinbrocker’s stages 1, 2, 3 and 4 were identified 39, 48, 44 and 65 patients, respectively (Table.1). We identified any of hallux valgus, spread foot and flat foot in Steinbrocker’s stage 1. Moreover HVA and CP had progressed according to the progression of stage and disease duration. However, M1M2 and M1M5 had been progressed from the early stage. These findings indicate that foot deformities started from the early stage of RA and progressed with advancing stages.
Table 1. Development of foot deformities in patients with rheumatoid arthritis according to Steinbrocker’s stage.
|
Steinbrocker’s stage |
1 (n = 39) |
2 (n = 48) |
3 (n = 44) |
4 (n = 65) |
|
Disease duration (y) |
6.9 |
7.6 |
14.5 |
21.8 |
|
DAS28-ESR |
2.8 |
3.2 |
3.8 |
3.9 |
|
HVA (°) |
15.6 |
18.9 |
17.4 |
24.9 |
|
M1/M2 angle (°) |
9.5 |
10.5 |
9.7 |
9.4 |
|
M1/M5 angle (°) |
29.5 |
29.4 |
30.3 |
29.2 |
|
Calcaneal pitch (°) |
19.3 |
18.2 |
16.9 |
15.5 |
|
Hallux valgus (%) |
47.4 |
59.4 |
50.6 |
63.5 |
|
Spread foot (%) |
41.6 |
40.6 |
44.8 |
42.1 |
|
Flat foot (%) |
52.6 |
58.3 |
67.8 |
73.8 |
Conclusion:
Foot deformities started from an early stage of RA, and correlated with disease stage and duration in patients with RA. This result suggests that the disease activity may be underestimated without the assessment of feet in routine clinical care. It is necessary to consider joint destruction and deformity of the foot from the early stage of RA.
Disclosure:
K. Mamoto,
None;
T. Koike,
Chugai Pharmaceutical,
2,
Eli Lilly Japan,
8,
Novartis Pharmaceutical Corporation,
2,
Teijin Pharma,
8,
Bristol-Myers Squibb,
5,
Ono Pharmaceutical,
8,
Santen Pharmaceutical,
8,
Eisai,
8,
Abbott Japan,
8,
Mitsubishi Tanabe Pharma Corporation,
2,
Takeda Pharmaceutical,
8,
Astellas Pharma Inc.,
8,
Pfizer Japan Inc.,
8,
Janssen Pharmaceutical,
2,
Asahi Kasei Pharma Corporation,
8,
Daiichi Sankyo Company,
2;
T. Okano,
None;
A. Kamiyama,
None;
Y. Sugioka,
None;
M. Tada,
None;
H. Nakamura,
None.
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