Prevalence of feet and ankle arthritis and their impact on clinical indices in patients with rheumatoid arthritis: a cross-sectional study

Sung Won Lee,Sung Hae Chang,Seong-Yong Kim

doi:10.1186/s12891-019-2773-z

Sung Won Lee, Sung Hae Chang + Show 1 more

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https://doi.org/10.1186/s12891-019-2773-z

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Abstract

BackgroundWe aimed to evaluate the prevalence of foot and/or ankle arthritis (FAA) and its impact on clinical indices in patients with rheumatoid arthritis (RA).MethodsThis cross-sectional study used data from the Korean College of Rheumatology Biologics & Targeted therapy registry to observe clinical outcomes of patients undergoing biologics therapy and conventional therapy. FAA was defined as ≥1 tender or swollen joint in the ankle and/or 1st-5th metatarsophalangeal (MTP) joints. Disease Activity Score 28 (DAS28), Routine Assessment of Patient Index Data 3 (RAPID3), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) were assessed.ResultsAmong 2046 patients, 598 had FAA. The ankle joint was the most commonly involved joint in FAA (tender joint, 71.4%; swollen joint, 59.5%), followed by the third and second MTP joints. Patients with FAA showed higher DAS28, RAPID3, SDAI, and CDAI scores. FAA presence was significantly associated with non-remission as per DAS28-ESR (odds ratio, 3.4; 95% confidence interval, 2.0–5.8), DAS28-CRP (3.6, 2.4–5.3), SDAI (6.3, 2.8–14.6), CDAI (7.6, 2.4–24.3), and RAPID3 (5.6, 2.7–11.5) indices on adjusting for age, sex, disease duration, presence of rheumatoid factor, presence of anti-cyclic citrullinated peptide antibody, lung disease, use of methotrexate, and previous use of biological disease-modifying anti-rheumatic drugs. Patients with FAA were less likely to achieve remission of SDAI (n = 6, 1.0%) and CDAI (n = 3, 0.5%) than that of DAS28-ESR (n = 21, 3.5%), DAS28-CRP (n = 38, 6.4%), and RAPID3 (n = 12, 2.0%).ConclusionsFAA represents a severe disease activity and is an independent risk factor for non-remission in patients with RA.

Highlights

We aimed to evaluate the prevalence of foot and/or ankle arthritis (FAA) and its impact on clinical indices in patients with rheumatoid arthritis (RA)
RA can be assessed using various parameters; the disease activity indexes are comprised of multiple factors, including patient’s global assessment (PGA), evaluator’s global assessment (EGA), C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR) to measure joint
Wechalekar et al reported that 43% of patients with a Disease Activity Score 28 (DAS28)-ESR of < 2.6 had foot synovitis, and 25– 36% of patients with remission as per simplified disease activity index (SDAI) and clinical disease activity index (CDAI) had foot synovitis [8]

Summary

Introduction

We aimed to evaluate the prevalence of foot and/or ankle arthritis (FAA) and its impact on clinical indices in patients with rheumatoid arthritis (RA). Foot and ankle are commonly affected, and more than 90% of patients with RA reported foot pain during the course of RA can be assessed using various parameters; the disease activity indexes are comprised of multiple factors, including patient’s global assessment (PGA), evaluator’s global assessment (EGA), C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR) to measure joint. Simplified disease activity index (SDAI) or clinical disease activity index (CDAI) was developed, which offers simpler calculation with the arithmetic sum of swollen joint counts (SJS), tender joint counts (TJC), PGA, EGA, CRP for SDAI and SJS, TJC, PGA, EGA for CDAI for CDAI [4, 6]. The disease activity index excludes foot and ankle joints, and there have been controversies whether these composite indices represent the actual disease activity involving foot and ankle joints [8,9,10,11]. Wechalekar et al reported that 43% of patients with a DAS28-ESR of < 2.6 had foot synovitis, and 25– 36% of patients with remission as per SDAI and CDAI had foot synovitis [8]

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