title: Prevalence and course of forefoot impairments and walking disability in the first eight years of rheumatoid arthritis.
abstract: 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.
authors.affiliation: Jan van Breemen Institute, Amsterdam, The Netherlands. m.vd.leeden@janvanbreemen.nl
authors.forename: Marike
authors.initials: M
authors.lastname: van der Leeden
authors.forename: Martijn P M
authors.initials: MP
authors.lastname: Steultjens
authors.forename: Jennie
authors.initials: J
authors.lastname: Ursum
authors.forename: Rutger
authors.initials: R
authors.lastname: Dahmen
authors.forename: Leo D
authors.initials: LD
authors.lastname: Roorda
authors.forename: Dirkjan Van
authors.initials: DV
authors.lastname: Schaardenburg
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
mesh_terms: 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