title: The prevalence of foot ulceration in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To establish the prevalence of foot ulceration in patients with rheumatoid arthritis (RA) in secondary care.
  
  
  METHODS
  A postal survey of all patients with RA (n = 1,130) under the care of rheumatologists in Bradford, West Yorkshire, UK was performed. The prevalence data were validated through clinical examination, case-note review, and contact with health professionals. The false-negative rate was investigated in a subsample of patients (n = 70) who denied any history of ulceration.
  
  
  RESULTS
  The postal survey achieved a 78% response rate. Following validation, the point prevalence of foot ulceration was 3.39% and the overall prevalence was 9.73%. The false-positive rate was initially high at 21.21%, but use of diagrammatic questionnaire data to exclude leg ulceration reduced the rate to 10.76%. The false-negative rate was 11.76%. The most common sites for ulceration were the dorsal aspect of hammer toes, the metatarsal heads, and the metatarsophalangeal joint in patients with hallux abducto valgus, with 33% of patients reporting multiple sites of ulceration. Patients with open-foot and healed-foot ulceration had significantly longer RA disease duration, reported significantly greater use of special footwear, and had a higher prevalence of foot surgery than ulcer-free patients.
  
  
  CONCLUSIONS
  Foot ulceration affects a significant proportion of patients with RA. Further work is needed to establish risk factors for foot ulceration in RA and to target foot health provision more effectively.
authors.affiliation: Postgraduate Suite, School of Healthcare, Baines Wing, University of Leeds, Leeds, UK. J.Firth@leeds.ac.uk
authors.forename: Jill
authors.initials: J
authors.lastname: Firth
authors.forename: Claire
authors.initials: C
authors.lastname: Hale
authors.forename: Philip
authors.initials: P
authors.lastname: Helliwell
authors.forename: Jackie
authors.initials: J
authors.lastname: Hill
authors.forename: E Andrea
authors.initials: EA
authors.lastname: Nelson
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D003625:Data Collection / Q000592:standards; D005188:False Negative Reactions; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology*; D006215:Hallux Valgus / Q000453:epidemiology; D037801:Hammer Toe Syndrome / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011177:Postal Service; D015995:Prevalence; D015203:Reproducibility of Results; D012720:Severity of Illness Index