Hang 10: Is the Jury Still Out on Rheumatoid Arthritis Feet?

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This is part 2 of a series on RA feet. Yesterday, I conveyed my skepticism about failing to “count” Rheumatoid Arthritis forefeet when measuring disease activity.

“Individuals with rheumatoid arthritis (RA) experience debilitating foot pain and deformity, which in turn contributes to the substantial physical disability well-documented in this population. More than 70% of all individuals with RA report moderate to severe foot pain, exposing a significant clinical challenge and an international public health priority. Effective management of foot pain and prevention of foot deformity are the chief goals of intervention to this challenge. Increasingly, a team approach is used to institute multidisciplinary care. Despite the high prevalence of foot issues, there remain several significant barriers to effective foot care, and evidence indicates that the majority of patients with RA do not access foot care.”

RA feet: a hallmark symptom?

Hang Ten logo screenshotI appreciated this practical editorial on the topic of RA feet by Smita Rao, a physical therapist at New York University. Rao calls foot deformity the “pathognomonic in RA,” which I found ironic since feet were only recently included in diagnostic criteria for RA (toe joints can be considered “small joints”). And, as we discussed yesterday, investigators have again determined that measuring feet is unnecessary to gauge disease activity.

Cool word, pathognomonic, says this Grecophile.

The article, “Quantifying Foot Function in Individuals With Rheumatoid Arthritis: Recent Advances and Clinical Implications,” was prompted by two new 3-D motion studies on RA published in this month’s Arthritis Care & Research. Both studies make valuable contributions to the evidence about what happens to the feet of a person with Rheumatoid disease, using state of the art technology to evaluate “inflammatory and mechanical” processes that contribute to foot disability.

The first, “Foot and Ankle Kinematics in Rheumatoid Arthritis: Influence of Foot and Ankle Joint and Leg Tendon Pathologies,” examines how gait changes from the early stages of RA, as a result of disease effects on feet and ankles.

The second, “Tibialis Posterior Tenosynovitis and Associated Pes Plano Valgus in Rheumatoid Arthritis: Electromyography, Multisegment Foot Kinematics, and Ultrasound Features,” studies how muscle function is altered as a result of the way tendons are affected by the disease.

Bottom line on our bottom joints

The feet, like the neck and the hands, are affected in most people with Rheumatoid disease. And the involvement can develop in various ways. Since the disease does not limit itself to synovial membranes or to hands, we must broaden the perspective of clinicians and investigators to improve care for people with Rheumatoid disease. I welcome Dr. Rao’s perspective as a physical therapist: “Also, if we are indeed to help our patients, objective evidence is urgently necessary that will allow us to test interventions and aid treatment in the critical area of foot issues in our patients with RA.”

Until there is a cure, knowing “the majority of patients with RA do not access foot care” is not acceptable.

Recommended reading

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Kelly Young. All rights reserved.

This entry was posted on Wednesday, April 3rd, 2013 at 4:55 am and is filed under The Real Rheumatoid Disease. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.


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