Clinical evaluation of foot disability in patients with axial spondyloarthritis

Abstract

Objective: To evaluate foot disability both ultrasonographically and by using the Foot Function Index (FFI) in patients with axial spondyloarthritis (SpA) and to investigate its effects on patients' quality of life and functional capacity by determining the factors that may affect the level of disability.Patients and methods. A total of 100 patients were included in the study. Enthesis sites in the feet were assessed for tenderness and swelling. Ultrasonographic examination of the Achilles tendon and plantar fascia was made and the findings were scored according to Glasgow Ultrasound Enthesitis Scoring System (GUESS). The Foot Function Index (FFI) was used to investigate the effects of foot disorders on disability and activity limitation. The correlation between GUESS and FFI scores, and relationship of GUESS and FFI scores with age, disease duration, body mass index (BMI), smoking and disease activity parameters were investigated.Results and discussion. Physical examination revealed signs of enthesitis in 13 (13%) patients, while ultrasonographic (USG) evaluation – in 36 (36%) patients. A statistically significant correlation was found between all FFI and GUESS scores except between FFI for the right foot and GUESS for right Achilles tendon enthesitis. A positive correlation was found between age and BMI and FFI (p<0.05). There was no correlation between disease duration and smoking and FFI scores. While there was a statistically significant correlation between all scores of GUESS and age, disease duration, and BMI, no correlation was found between smoking and GUESS scores. No significant difference was found in either FFI or GUESS scores between patients with or without / diabetes and patients who were smokers or non-smokers. All FFI and GUESS scores significantly correlated with BASDAI, ASDAS, BASFI, and ASQoL (p<0.05).Conclusion. Enthesitis may lead to decreased functional capacity and loss of quality of life in ax-SpA patients. Subclinical enthesitis in the feet of patients with SpA is not rare and may be detected by USG.