title: Erosions in the foot at baseline are predictive of orthopaedic shoe use after 10 years of treat to target therapy in patients with recent onset rheumatoid arthritis.
abstract: The objective of this study is to investigate if foot joint damage due to rheumatoid arthritis (RA) can predict whether patients will start wearing orthopaedic shoes (OS) within 10 years after treatment start. Data from recent onset RA patients with 10 years follow-up from the BeSt (Dutch acronym for treatment strategies) study were used. Treatment was tightly controlled, targeted at disease activity score (DAS) ≤2.4, according to 1 of 4 pre-specified treatment strategies. After 10 years of follow-up, orthopaedic shoe use was recorded in 285/508 patients (responders to questionnaires at 10 years). Between-group differences for orthopaedic shoe users and non-users were calculated at baseline, after 10 years, and change scores over the 10-year period were calculated. Predictors for orthopaedic shoe use were identified by univariable and multivariable logistic regression analyses. Orthopaedic shoe use was reported by 57/285 patients after 10 years. Orthopaedic shoe users had more joint damage, joint swelling and pain in the feet already at baseline and after 10 years. At both time points, DAS of orthopaedic shoe users and non-users was similar. Multivariable logistic regression showed that dichotomized foot erosions score (cut-off ≥1 erosion) (OR 2.42), anti-citrullinated protein antibodies (ACPA) (OR 4.64) and DAS (OR 1.77) were independent predictors of orthopaedic shoe use. Despite intensive targeted treatment, 57/285 recent onset RA patients started using orthopaedic shoes over 10 year of follow-up. Presence of foot erosions at treatment start predicts orthopaedic shoe use after 10 years. The risk of orthopedic shoe use increased for ACPA-positive patients and for those with higher baseline disease activity.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. S.A.Bergstra@lumc.nl.
authors.forename: Sytske Anne
authors.initials: SA
authors.lastname: Bergstra
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Iris M
authors.initials: IM
authors.lastname: Markusse
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Gülşah
authors.initials: G
authors.lastname: Akdemir
authors.affiliation: Department of Rheumatology, Haga-Leyenburg Teaching Hospital, The Hague, The Netherlands.
authors.forename: H Karel
authors.initials: HK
authors.lastname: Ronday
authors.affiliation: Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: K Huub
authors.initials: KH
authors.lastname: Han
authors.affiliation: Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands.|Department of Rheumatology, Reade, Amsterdam, The Netherlands.
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.affiliation: Department of Rheumatology, Reade, Amsterdam, The Netherlands.
authors.forename: Pit J S M
authors.initials: PJSM
authors.lastname: Kerstens
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Rosaline
authors.initials: R
authors.lastname: van den Berg
authors.affiliation: Amsterdam Rheumatology & Immunology Center, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.|Amsterdam Rheumatology & Immunology Center, Atrium Medical Center Heerlen, Heerlen, The Netherlands.
authors.forename: Robert B M
authors.initials: RBM
authors.lastname: Landewé
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D033023:Foot Joints / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D009989:Orthotic Devices / Q000009:adverse effects*; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D012775:Shoes
chemical_list: D018501:Antirheumatic Agents
keywords: Erosions; Orthopaedic shoes; Rheumatoid arthritis; Risk factors