Prevalence and course of forefoot impairments and walking disability in the first eight years of rheumatoid arthritis.
OBJECTIVE
To evaluate the prevalence and 8-year course of forefoot impairments and walking disability in patients with rheumatoid arthritis (RA).


METHODS
A total of 848 patients with recent-onset RA from 1995 through the present were included. The patients were assessed annually. Pain and swelling of the metatarsophalangeal (MTP) joints, erosions and joint space narrowing of the MTP joints and first interphalangeal joints, and the Health Assessment Questionnaire walking subscale were analyzed using descriptive and correlational techniques.


RESULTS
Pain and swelling of > or = 1 MTP joint was present in 70% of patients at baseline, decreasing to approximately 40-50% after 2 years. The forefoot erosion score was > or = 1 in 19% of the patients at baseline, and the prevalence of forefoot erosion increased to approximately 60% after 8 years, during which the mean forefoot erosion score increased from 1.3 to 7.9. At least mild walking disability was present in 57% of patients at baseline, stabilizing at approximately 40% after 1 year.


CONCLUSIONS
The prevalence rates for pain and swelling of the MTP joints and walking disability are initially high and then stabilize, but the prevalence and severity of forefoot joint damage increase during an 8-year course of RA. The findings of this study quantitatively emphasize the importance of forefoot involvement in patients with RA.
van der Leeden
Marike
M
Jan van Breemen Institute, Amsterdam, The Netherlands. m.vd.leeden@janvanbreemen.nl
Steultjens
Martijn P M
MP
Ursum
Jennie
J
Dahmen
Rutger
R
Roorda
Leo D
LD
Schaardenburg
Dirkjan Van
DV
Dekker
Joost
J
D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology*; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D033023:Foot Joints / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009426:Netherlands; D015995:Prevalence; D012720:Severity of Illness Index