title: The foot: still the most important reason for walking incapacity in rheumatoid arthritis: distribution of symptomatic joints in 1,000 RA patients.
abstract: OBJECTIVE
  Our knowledge of frequency of foot involvement in rheumatoid arthritis (RA) is still often based on a study from Finland in 1956. Great changes in the treatment of RA may have led to a different situation. We investigated the distribution of joint involvement in RA patients today, with special attention given to the feet and subjective walking ability.
  
  
  METHODS
  1,000 RA patients answered a questionnaire concerning joints affected, joint surgery, foot problems, and subjectively experienced reasons for walking incapacity.
  
  
  RESULTS
  In 45% of the patients, the forefoot was involved at the start of the disease. In 17%, the hindfoot/ankle was involved at the start. Only hand symptoms were commoner. 80% of patients reported current foot problems, 86% in the forefoot and 52% in the hindfoot/ankle. Difficulty in walking due to the feet was reported by 71%. For 41% of patients, the foot was the most important part of the lower extremity causing reduced walking capacity, and for 32% it was the only part.
  
  
  CONCLUSIONS
  After the hand, the foot was the most frequently symptomatic joint complex at the start of the disease, but also during active medical treatment. The foot caused walking disability in three-quarters of the cases and-4 times as often as the knee or the hip-it was the only joint to subjectively impair gait.
authors.affiliation: Department of Molecular Medicine and Surgery, Orthopedic Rehabilitation, Karolinska Institute, Red Cross Hospital, Stockholm, Sweden. lollo.grondal@rks.se
authors.forename: Lollo
authors.initials: L
authors.lastname: Grondal
authors.forename: Birgitta
authors.initials: B
authors.lastname: Tengstrand
authors.forename: Birgitta
authors.initials: B
authors.lastname: Nordmark
authors.forename: Per
authors.initials: P
authors.lastname: Wretenberg
authors.forename: Andre
authors.initials: A
authors.lastname: Stark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000503:physiopathology* / Q000601:surgery; D004185:Disability Evaluation; D005260:Female; D005528:Foot / Q000503:physiopathology*; D033023:Foot Joints / Q000503:physiopathology* / Q000601:surgery; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology*