The clinical importance of ultrasound detectable forefoot bursae in rheumatoid arthritis

Bowen, Catherine; Culliford, David; Dewbury, K. C.; Sampson, Madeleine; Burridge, Jane; Hooper, Lindsey; Edwards, Christopher J; Arden, N K

doi:10.1093/rheumatology/kep307

Cited by 32 publications

(45 citation statements)

References 9 publications

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“…In this patient group, clinical strategies to offload peak pressures over time may therefore require additional information, such as US imaging to prevent overloading of potential current soft tissue inflammation that may not be detected clinically [7,29,30]. …”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Thus, a rapid identification of RA related bursitis can be essential to adopt an appropriate therapy [38]. The role of US in detecting bursitis in RA patients has poorly been investigated and has been mainly focused on shoulder and foot disease [39][40][41][42][43][44][45]. At shoulder level subdeltoid bursitis can be a cause of pain and functional impairment contributing to the global involvement of shoulder in RA patients; it is estimated that 70% of RA patients suffer from shoulder pain [39].…”

Section: C) Bursitismentioning

confidence: 99%

“…In particular the presence of forefoot bursae in RA patients has been recently studied [44,45]. Bowen et al reported a prevalence of US detectable foot bursae of 92.6% in RA patients.…”

Section: C) Bursitismentioning

confidence: 99%

“…Bowen et al reported a prevalence of US detectable foot bursae of 92.6% in RA patients. They also demonstrated that US was superior to clinical examination which identified foot bursitis only in 23.5% of patients [44]. Same authors in 2010 [46] assessed foot of RA patients at baseline and after 12 months in order to detect forefoot bursae and determine their natural history and clinical significance.…”

Section: C) Bursitismentioning

confidence: 99%

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11 Ultrasound for Rheumatoid Arthritis

Dogra¹,

Gaitini²,

Monu³

2010

Musculoskeletal Ultrasound With MRI Correlations

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Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial inflammation that can lead to structural damage of cartilage, bone and tendons. Assessing the inflammatory activity and the severity is essential in RA to help rheumatologists in adopting proper therapeutic strategies and in evaluating disease outcome and response to treatment. In the last years musculoskeletal (MS) ultrasonography (US) underwent tremendous technological development of equipment with increased sensitivity in detecting a wide set of joint and soft tissues abnormalities. In RA MSUS with the use of Doppler modalities is a useful imaging tool to depict inflammatory abnormalities (i.e. synovitis, tenosynovitis and bursitis) and structural changes (i.e. bone erosions, cartilage damage and tendon lesions). In addition, MSUS has been demonstrated to be able to monitor the response to different therapies in RA to guide local diagnostic and therapeutic procedures such as biopsy, fluid aspirations and injections. Future applications based on the development of new tools may improve the role of MSUS in RA.

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“…The high increased prevalence of foot and ankle pathologies in rheumatic and musculoskeletal diseases (RMDs) is well documented Grondal, Tengstrand, Nordmark, Wretenberg, & Stark, 2008;Otter et al, 2010;Sari-Kouzel et al, 2001;Woodburn & Helliwell, 1997), with studies suggesting that up to 90% of patients are affected in conditions such as rheumatoid arthritis (Otter et al, 2010). Research is now confirming the profound impact that foot and ankle conditions have on patients across the spectrum of RMDs (Bowen et al, 2010;Helliwell et al, 2005). Despite this, very little is known about the provision of services to address the foot health needs of people with RMDs in Europe.…”

Section: Introductionmentioning

confidence: 99%

Provision of foot and ankle care services for people with rheumatic and musculoskeletal disease across Europe

Alcacer‐Pitarch

Backhouse

Gijon-Nogeron

et al. 2019

Musculoskeletal Care

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Background The aim of the present study was to explore the variation in the provision of care for people with rheumatic and musculoskeletal diseases (RMDs), and foot and ankle problems between European healthcare systems. Methods An electronic questionnaire was developed and piloted in seven countries prior to being distributed to the presidents of all 22 national health professionals in rheumatology associations within the European League Against Rheumatism (EULAR). Summary data were obtained using SPSS V22. Ethical approval was sought from the Medical Research Ethics Committee of University of Malaga (CEUMA‐91‐2015‐H). Results Sixteen questionnaires (73% response rate) were completed (Austria, Belgium, Czech Republic, Denmark, France, Hungary, Ireland, Italy, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK). All 16 respondents indicated that foot and ankle healthcare services were provided in their country, but only three countries had services specializing in RMD‐related foot and ankle problems (the Netherlands, the UK and Malta). The professions providing care varied, depending on the pathology and the country. Foot and ankle pain was mostly treated by rheumatologists and physiotherapists; foot and ankle deformities by orthopaedic surgeons and orthotist/prosthetists; and foot and ankle ulcers by nurses. Services were predominantly delivered through the public sector, and in secondary care (hospital) settings. Conclusions Only three countries reported having specialist foot and ankle services addressing the needs of people with RMDs. Variation was seen in the professions which provided care between countries, and also between the foot and ankle pathologies cared for. There is a lack of clinical pathways and guidelines for the management of patients with RMD‐related foot and ankle problems.

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The clinical importance of ultrasound detectable forefoot bursae in rheumatoid arthritis

Cited by 32 publications

References 9 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

11 Ultrasound for Rheumatoid Arthritis

Provision of foot and ankle care services for people with rheumatic and musculoskeletal disease across Europe

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