title: To what extent is foot pain related to biomechanical changes and ultrasound-detected abnormalities in rheumatoid arthritis?
abstract: OBJECTIVE
  To investigate the presence of biomechanical abnormalities and ultrasound (US)-detected inflammation and damage in low disease or remission status rheumatoid arthritis (RA) patients with foot complaints.
  
  
  METHODS
  We recruited 136 subjects with foot complaints. Sixty-two were biologic disease-modifying antirheumatic drug-treated RA patients presenting Disease Activity Score-determined remission or low disease activity while the remaining 74 were gender matched controls without rheumatic or musculoskeletal disorders. Both groups underwent a comprehensive podiatric, biomechanical and B-mode and Doppler US assessment of the feet.
  
  
  RESULTS
  Most RA patients and controls were female (77.4% and 83.8%, respectively). There was no statistical difference in the proportion of obese subjects in either group (p=0.792). Inappropriate shoes were used by 50.0% of RA patients and 33.8% of controls (p=0.080). Talalgia, particularly heel pain, was more frequent in the control group, with associated talalgia and metatarsalgia being more prevalent in the RA group (p<0.05). The RA patient group was also more likely to present greater foot deformity, more limited joint movement and biomechanical abnormalities than the controls (p<0.05). US inflammatory and structural changes were significantly more frequent in RA patients than in controls (p<0.05). US structural involvement was significantly associated with limited joint mobility and pathologic biomechanical tests only in RA patients (p<0.05).
  
  
  CONCLUSIONS
  RA foot complaints seemed to be linked to US-detected RA involvement and biomechanical abnormalities. Podiatric and US assessments can be useful to help the clinician to optimise the management of RA patients in remission/low disease activity with foot complaints.
authors.affiliation: University Podiatry Clinic, Faculty of E.F. Podiatry Universidad Complutense de Madrid, Spain.
authors.forename: María Luz
authors.initials: ML
authors.lastname: González-Fernández
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. lvalor.hgugm@salud.madrid.org.
authors.forename: Lara
authors.initials: L
authors.lastname: Valor
authors.affiliation: University Podiatry Clinic, Faculty of E.F. Podiatry Universidad Complutense de Madrid, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Morales-Lozano
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Hernández-Flórez
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: López-Longo
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Martínez
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Carlos Manuel
authors.initials: CM
authors.lastname: González
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Indalecio
authors.initials: I
authors.lastname: Monteagudo
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Martínez-Barrio
authors.affiliation: Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Garrido
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D001696:Biomechanical Phenomena / Q000502:physiology; D005260:Female; D005531:Foot Deformities, Acquired / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D033023:Foot Joints / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D037061:Metatarsalgia / Q000175:diagnosis*; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler / Q000379:methods