Abstract
BackgroundThe prevalence of foot ulcers in patients with rheumatoid arthritis (RA) has been reported at almost 10 %. These foot ulcers often occur at multiple sites and are reoccurring, with the potential risk of infection increased due to RA diagnosis and disease modifying medications. The objective of this study was to estimate the prevalence of clinical infection in foot-ulcers of patients with RA; describe the microbiological characteristics and investigate risk factors.MethodsRetrospective clinical data was collected for all patients attending a rheumatology foot ulcer clinic between 1st May 2012 and 1st May 2013: wound swab data was collected from those with clinical infection.ResultsTwenty-eight patients with RA and foot-ulcers were identified; eight of these patients had clinical infection and wound swabs taken (29 %).Of these eight patients there were equal men and women, with median age 74 years, and average disease duration 22 years.Cardiovascular disease/peripheral-vascular disease (CVD/PVD) were reported in six patients, diabetes in two patients.Six patients were treated with disease-modifying anti-rheumatic drugs (DMARDs); three were on biologic medications and two on steroids.Five wound swabs cultured skin flora, one staphylococcus aureus, one had no growth after culture; and one was rejected due to labelling error.ConclusionAlmost a third of people with RA and foot ulcers attending clinic over one year had clinical infection, however microbiological analysis failed to isolate pathogens in six of seven wound swabs. This may be due to inaccurate diagnosis of ulcer infection or to issues with sampling, collection, transport, analysis or reporting. There was insufficient data to relate risk of clinical infection with risk factors.Further research is required to identify the most appropriate techniques for infection diagnosis, wound sampling and processing.Trial registrationEthical approval was obtained from University of Leeds, Faculty of Medicine and Health (Reference number: SHREC/RP/349).
Highlights
The prevalence of foot ulcers in patients with rheumatoid arthritis (RA) has been reported at almost 10 %
The prevalence of foot-ulcers found in a self-report postal study of RA patients in Bradford, West Yorkshire was almost 10 %, if patients with coexisting diabetes were excluded this would change to 3.13 % [5]
Clinical diagnosis of infection is determined through signs and symptoms and reliant on the experience of individual practitioners [9], the validity of such a tool has yet to be proven in RA patients
Summary
The prevalence of foot ulcers in patients with rheumatoid arthritis (RA) has been reported at almost 10 % These foot ulcers often occur at multiple sites and are reoccurring, with the potential risk of infection increased due to RA diagnosis and disease modifying medications. The prevalence of foot-ulcers found in a self-report postal study of RA patients in Bradford, West Yorkshire was almost 10 %, if patients with coexisting diabetes were excluded this would change to 3.13 % [5] These foot-ulcers of patients with RA often occur at multiple sites and almost 50 % of patients suffer from recurrent ulcers [5, 7]. In the authors experience microbiology reports typically take several days to reach the clinician so selection of first line, empirical, antibiotic therapy is based on prior knowledge of likely infective organisms in the specific clinical population
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
