Forefoot joint damage, pain and disability in rheumatoid arthritis patients with foot complaints: the role of plantar pressure and gait characteristics

Leeden, M. van der; Steultjens, Martijn; Prins, A.; Dekker, J.

doi:10.1093/rheumatology/kei186

Cited by 137 publications

(61 citation statements)

References 21 publications

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“…In this study analysis, we found no difference in the location of peak plantar pressures between the RA and healthy participants although our results indicate that RA participants have significantly higher values of peak plantar pressures than healthy participants. The latter findings concur with those of other investigators [13,14,31]. Our evidence that, over time, changes in US detectable soft tissue pathology appear to be out of phase with changes in foot-shoe interface pressures both temporally and spatially does support the suggestion that these patients biomechanically adapt their gait away from forefoot pathology.…”

Section: Discussionsupporting

confidence: 93%

Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months

Bowen

Culliford

Allen

et al. 2011

Journal of Foot and Ankle Research

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BackgroundPlantar pressures are commonly used as clinical measures, especially to determine optimum foot orthotic design. In rheumatoid arthritis (RA) high plantar foot pressures have been linked to metatarsophalangeal (MTP) joint radiological erosion scores. However, the sensitivity of foot pressure measurement to soft tissue pathology within the foot is unknown. The aim of this study was to observe plantar foot pressures and forefoot soft tissue pathology in patients who have RA.MethodsA total of 114 patients with established RA (1987 ACR criteria) and 50 healthy volunteers were assessed at baseline. All RA participants returned for reassessment at twelve months. Interface foot-shoe plantar pressures were recorded using an F-Scan® system. The presence of forefoot soft tissue pathology was assessed using a DIASUS musculoskeletal ultrasound (US) system. Chi-square analyses and independent t-tests were used to determine statistical differences between baseline and twelve months. Pearson's correlation coefficient was used to determine interrelationships between soft tissue pathology and foot pressures.ResultsAt baseline, RA patients had a significantly higher peak foot pressures compared to healthy participants and peak pressures were located in the medial aspect of the forefoot in both groups. In contrast, RA participants had US detectable soft tissue pathology in the lateral aspect of the forefoot. Analysis of person specific data suggests that there are considerable variations over time with more than half the RA cohort having unstable presence of US detectable forefoot soft tissue pathology. Findings also indicated that, over time, changes in US detectable soft tissue pathology are out of phase with changes in foot-shoe interface pressures both temporally and spatially.ConclusionsWe found that US detectable forefoot soft tissue pathology may be unrelated to peak forefoot pressures and suggest that patients with RA may biomechanically adapt to soft tissue forefoot pathology. In addition, we have observed that, in patients with RA, interface foot-shoe pressures and the presence of US detectable forefoot pathology may vary substantially over time. This has implications for clinical strategies that aim to offload peak plantar pressures.

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Section: Discussionsupporting

confidence: 93%

Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months

Bowen

Culliford

Allen

et al. 2011

Journal of Foot and Ankle Research

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“…In RA, plantar pressure has been shown to be elevated at the MTP joints, and this has been associated with pain and disability [6–8]. In this PsA study, these results could not be replicated, with limited evidence for elevated plantar pressure and for plantar pressure predicting which joints are painful.…”

Section: Discussionmentioning

confidence: 76%

“…It is recognized that the causes of pain at the MTP joint level are complex and may not be wholly related to inflammation [3] and that increased mechanical pressure over structurally damaged metatarsal heads may be important [5–6]. Indeed, in RA, MTP joint peak pressures are elevated and significant relationships between high forefoot pressures, structural damage, pain and foot-related disability have been demonstrated [6–8]. Therefore we hypothesize that the same mechanisms may be equally important in PsA—but this has not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Metatarsophalangeal joint pain in psoriatic arthritis: a cross-sectional study

et al. 2013

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Objective. The aim of this study was to identify independent predictors of pain at the MTP joints in patients with PsA.Methods. Thirty-four consecutive patients with PsA (mean age 45.3 years, 65% female, mean disease duration 9.9 years) and 22 control participants (mean age 37.9 years, 64% female) underwent clinical and US examination to determine the presence of pain, swelling, synovitis, erosions, effusions and submetatarsal bursae at the MTP joints. Mean barefoot peak plantar pressures were determined at each MTP joint. Levels of pain, US-determined pathology and peak pressures were compared between groups. Binary logistic regression was used to identify demographic, clinical examination-derived, US-derived and plantar pressure predictors of pain at the MTP joints in the PsA group.Results. The presence of pain, deformity, synovitis, erosions (P < 0.001) and submetatarsal bursae and peak plantar pressure at MTP 3 (P < 0.05) were significantly higher in the PsA group. MTP joint pain in PsA was independently predicted by high BMI, female gender and the presence of joint subluxation, synovitis and erosion.Conclusion. These results suggest local inflammatory and structural factors, together with systemic factors (gender, BMI), are predominantly responsible for painful MTP joints in PsA, with no clear role for plantar pressure characteristics.

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“…The increase removal of osteoclasts from the cartilage as inflammatory response is observable in the form of bone erosion in the histological examination of joints [46, 47]. The treatments which are capable of inhibiting the joint inflammation are considered to be therapeutically efficient for RA [48, 49]. The histological examination of the arthritic joints treated with indomethacin exhibited mild inflammatory cell migration.…”

Section: Discussionmentioning

confidence: 99%

The Anti-Arthritic and Immune-Modulatory Effects of NHAG: A Novel Glucosamine Analogue in Adjuvant-Induced Arthritis

Shah

Jawed

Awan

et al. 2013

BioMed Research International

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Rheumatoid arthritis (RA) is potentially devastating condition which lacks good treatment options. Pro-inflammatory cytokines interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and oxidative stress markers such as nitric oxide (NO) and peroxide (PO) are mediators of RA pathogenesis. In the present study N-[2,4,5-trihydroxy-6-(hydroxymethyl) tetrahydro-2H-pyran-3-yl]acrylamide (NHAG), analogue of glucosamine, was evaluated in adjuvant-induced arthritic model of rats. The disease progression was monitored by analysing arthritis scoring, loss of body weight, paw oedema, and histological changes in joints. RA associated hyperalgesia was evaluated by gait analysis. The serum or plasma levels of NO, PO, glutathione (GSH) superoxide dismutase (SOD) IL-1β and TNF-α were analyzed to monitor the state of disease severity. The arthritic control animals exhibited significant increase in arthritic score (P < 0.003) and paw oedema (P < 0.001) with parallel loss in body weight (P < 0.04). The NHAG-treated arthritic animals exhibited refinement in the gait changes associated with arthritis. NHAG also significantly decreased the NO (P < 0.02) and PO (P < 0.03) with concurrent increased in GSH (P < 0.04) and SOD (P < 0.007). Both IL-1β (P < 0.001) and TNF-α (P < 0.001), were significantly decreased in NHAG-treated group. Thus NHAG might have a therapeutic potential for arthritis by exerting antioxidative and immunomodulatory effects.

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Forefoot joint damage, pain and disability in rheumatoid arthritis patients with foot complaints: the role of plantar pressure and gait characteristics

Cited by 137 publications

References 21 publications

Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months

Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months

Metatarsophalangeal joint pain in psoriatic arthritis: a cross-sectional study

The Anti-Arthritic and Immune-Modulatory Effects of NHAG: A Novel Glucosamine Analogue in Adjuvant-Induced Arthritis

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