The Assessment of the Quality of Life in Patients with Rheumatoid Foot

Monika      Chruściak; Ilona      Kowalik; Tomasz      Chruściak; Małgorzata      Wisłowska
Abstract

Background: The negative effects of rheumatoid arthritis (RA) are multi-dimensional. Foot deformities lead to disability, pain, and impaired quality of life.
Objective: Identifying the difficulties in functioning rheumatoid foot and assessing the quality of life in this aspect.
Materials and Methods: The material included 50 patients of Rheumatology Policlinic of the Central Clinical Hospital of Interior Affairs in Warsaw and a matched control group of 50 individuals without RA. The degree of foot joint damage was assessed using the Manchester scale, lower limb movement and quality of life using the American Orthopedic Foot and Ankle Society Score and HAQ.
Results: The duration of symptoms was 16.0 ± 8.9 years. High activity of RA measured by the DAS was observed in 20% of patients, moderate in 26%, and low in 54%. The most common foot deformities were: hammer toes (82%), longitudinal flat feet (74%), and hyperkeratosis (56%). The least frequent were: stiff toe (38%) and overlapping fingers (28%). In the RA group, the outcomes of the FAOS questionnaire were statistically significantly worse than in the control group in all categories (p<0.001). The worst-rated domain was the sport and recreation subscale (median 55.0), the best daily activity (median 86.8). The strongest relationship was demonstrated between the FAOS and HAQ indices. Spearman's HAQ correlation coefficient with the ADL subscale was r=-0.85, p<0.001; with the QOL, sport/recreation and pain subscales moderate, it was r=-0.72; r= 0.71, p <0.001.
Conclusion: Lower limb movement function and quality of life are worse in RA patients; pain accompanies climbing and descending stairs; running and jumping require effort.
Keywords: Rheumatoid arthritis, foot, quality of life, FAOS, HAQ, flatfoot, hallux valgus, disability.
Graphical Abstract

[1]
Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis  2020; 79(6): 685-99.
 [http://dx.doi.org/10.1136/annrheumdis-2019-216655] [PMID: 31969328]

[2]
Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League against rheumatism collaborative initiative. Arthritis Rheum  2010; 62(9): 2569-81.
 [http://dx.doi.org/10.1002/art.27584] [PMID: 20872595]

[3]
Menz HB, Munteanu SE. Radiographic validation of the Manchester scale for the classification of hallux valgus deformity. Rheumatology (Oxford)  2005; 44(8): 1061-6.
 [http://dx.doi.org/10.1093/rheumatology/keh687] [PMID: 15901901]

[4]
Yelin E, Trupin L, Wong B, Rush S. The impact of functional status and change in functional status on mortality over 18 years among persons with rheumatoid arthritis. J Rheumatol  2002; 29(9): 1851-7.
 [PMID: 12233878]

[5]
Yazıcı G, Yazıcı MV, Bayraktar D, Varol F, Güçlü Gündüz A, Bek N. Validity and reliability of the Turkish version of the self-reported foot and ankle score in patients with foot or ankle pain. Acta Orthop Traumatol Turc  2020; 54(4): 408-13.
 [http://dx.doi.org/10.5152/j.aott.2020.19185] [PMID: 32812874]

[6]
Göksel KA, Günaydin R, Adibelli ZH, Kaya T, Duruöz E. Foot deformities in patients with rheumatoid arthritis: The relationship with foot functions. Int J Rheum Dis  2010; 13(2): 158-63.
 [http://dx.doi.org/10.1111/j.1756-185X.2010.01465.x] [PMID: 20536601]

[7]
Borman P, Ayhan F, Tuncay F, Sahin M. Foot problems in a group of patients with rheumatoid arthritis: An unmet need for foot care. Open Rheumatol J  2012; 6: 290-5.
 [http://dx.doi.org/10.2174/1874312901206010290] [PMID: 23066434]

[8]
Brooks F, Hariharan K. The rheumatoid forefoot. Curr Rev Musculoskelet Med  2013; 6(4): 320-7.
 [http://dx.doi.org/10.1007/s12178-013-9178-7] [PMID: 23943297]

[9]
Wilson O, Hewlett S, Woodburn J, Pollock J, Kirwan J. Prevalence, impact and care of foot problems in people with rheumatoid arthritis: Results from a United Kingdom based cross-sectional survey. J Foot Ankle Res  2017; 10: 46.
 [http://dx.doi.org/10.1186/s13047-017-0229-y] [PMID: 29090022]

[10]
Wilson O, Hewlett S, Pollock J, et al. Population survey of the prevalence, impact and care of foot problems in people with rheumatoid arthritis. J Foot Ankle Res  2015; 8: A9.
 [http://dx.doi.org/10.1186/1757-1146-8-S1-A9]

[11]
Woodburn J, Hennessy K, Steultjens MP, McInnes IB, Turner DE. Looking through the ‘window of opportunity’: Is there a new paradigm of podiatry care on the horizon in early rheumatoid arthritis? J Foot Ankle Res  2010; 3: 8.
 [http://dx.doi.org/10.1186/1757-1146-3-8] [PMID: 20478038]

[12]
Espinoza F, Fabre S, Pers YM. Remission-induction therapies for early rheumatoid arthritis: Evidence to date and clinical implications. Ther Adv Musculoskelet Dis  2016; 8(4): 107-18.
 [http://dx.doi.org/10.1177/1759720X16654476] [PMID: 27493689]

[13]
Kapral T, Dernoschnig F, Machold KP, et al. Remission by composite scores in rheumatoid arthritis: Are ankles and feet important? Arthritis Res Ther  2007; 9(4): R72.
 [http://dx.doi.org/10.1186/ar2270] [PMID: 17662115]

[14]
Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn  1977; 18(4): 481-91.
 [http://dx.doi.org/10.1177/028418517701800415] [PMID: 920239]

[15]
Menz HB, Fotoohabadi MR, Wee E, Spink MJ. Validity of self-assessment of hallux valgus using the Manchester scale. BMC Musculoskelet Disord  2010; 11(1): 215.
 [http://dx.doi.org/10.1186/1471-2474-11-215] [PMID: 20854678]

[16]
Häkkinen A, Kautiainen H, Hannonen P, Ylinen J, Mäkinen H, Sokka T. Muscle strength, pain, and disease activity explain individual subdimensions of the health assessment questionnaire disability index, especially in women with rheumatoid arthritis. Ann Rheum Dis  2006; 65(1): 30-4.
 [http://dx.doi.org/10.1136/ard.2004.034769] [PMID: 15901635]

[17]
Lee SW, Kim SY, Chang SH. Prevalence of feet and ankle arthritis and their impact on clinical indices in patients with rheumatoid arthritis: A cross-sectional study. BMC Musculoskelet Disord  2019; 20(1): 420.
 [http://dx.doi.org/10.1186/s12891-019-2773-z] [PMID: 31506089]

[18]
Wechalekar MD, Lester S, Proudman SM, et al. Active foot synovitis in patients with rheumatoid arthritis: Applying clinical criteria for disease activity and remission may result in underestimation of foot joint involvement. Arthritis Rheum  2012; 64(5): 1316-22.
 [http://dx.doi.org/10.1002/art.33506] [PMID: 22135142]

[19]
Aletaha D, Wang X, Zhong S, Florentinus S, Monastiriakos K, Smolen JS. Differences in disease activity measures in patients with rheumatoid arthritis who achieved DAS, SDAI, or CDAI remission but not boolean remission. Semin Arthritis Rheum  2020; 50(2): 276-84.
 [http://dx.doi.org/10.1016/j.semarthrit.2019.09.005] [PMID: 31590930]

[20]
Anderson JK, Zimmerman L, Caplan L, Michaud K. Measures of rheumatoid arthritis disease activity: Patient (PtGA) and provider (PrGA) global assessment of disease activity, disease activity score (DAS) and disease activity score with 28-joint counts (DAS28), simplified disease activity index (SDAI), clinical disease activity index (CDAI), patient activity score (PAS) and patient activity score-II (PASII), routine assessment of patient index data (RAPID), rheumatoid arthritis disease activity index (RADAI) and rheumatoid arthritis disease activity index-5 (RADAI-5), chronic arthritis systemic index (CASI), patient-based disease activity score with ESR (PDAS1) and patient-based disease activity score without ESR (PDAS2), and mean overall index for rheumatoid arthritis (MOI-RA). Arthritis Care Res  2011; 63(11): S14-36.
 [http://dx.doi.org/10.1002/acr.20621] [PMID: 22588741]

[21]
Roos EM, Brandsson S, Karlsson J. Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int  2001; 22(10): 788-94.
 [http://dx.doi.org/10.1177/107110070102201004] [PMID: 11642530]

[22]
Sierevelt IN, Zwiers R, Schats W, et al. Measurement properties of the most commonly used foot-and ankle-specific questionnaires: the FFI, FAOS and FAAM. A systematic review. Knee Surg Sports Traumatol Arthrosc  2018; 26(7): 2059-73.
 [http://dx.doi.org/10.1007/s00167-017-4748-7] [PMID: 29026933]

[23]
Cöster MC, Bremander A, Rosengren BE, Magnusson H, Carlsson A, Karlsson MK. Validity, reliability, and responsiveness of the Self-Reported Foot And Ankle Score (SEFAS) in forefoot, hindfoot, and ankle disorders. Acta Orthop  2014; 85(2): 187-94.
 [http://dx.doi.org/10.3109/17453674.2014.889979] [PMID: 24564747]

[24]
Negahban H, Mazaheri M, Salavati M, et al. Reliability and validity of the foot and ankle outcome score: A validation study from Iran. Clin Rheumatol  2010; 29(5): 479-86.
 [http://dx.doi.org/10.1007/s10067-009-1344-3] [PMID: 20140474]

[25]
Dansie EJ, Turk DC. Assessment of patients with chronic pain. Br J Anaesth  2013; 111(1): 19-25.
 [http://dx.doi.org/10.1093/bja/aet124] [PMID: 23794641]

[26]
Mani SB, Brown HC, Nair P, et al. Validation of the foot and ankle outcome score in adult acquired flatfoot deformity. Foot Ankle Int  2013; 34(8): 1140-6.
 [http://dx.doi.org/10.1177/1071100713483117] [PMID: 23513031]

[27]
Cöster M, Karlsson MK, Nilsson JA, Carlsson A. Validity, reliability, and responsiveness of a Self-Reported Foot And Ankle Score (SE-FAS). Acta Orthop  2012; 83(2): 197-203.
 [http://dx.doi.org/10.3109/17453674.2012.657579] [PMID: 22313352]

[28]
Kvien TK, Uhlig T. Quality of life in rheumatoid arthritis. Scand J Rheumatol  2005; 34(5): 333-41.
 [http://dx.doi.org/10.1080/03009740500327727] [PMID: 16234180]

[29]
Lillegraven S, Kvien TK. Measuring disability and quality of life in established rheumatoid arthritis. Best Pract Res Clin Rheumatol  2007; 21(5): 827-40.
 [http://dx.doi.org/10.1016/j.berh.2007.05.004] [PMID: 17870030]

[30]
Linde L, Sørensen J, Østergaard M, Hørslev-Petersen K, Hetland ML. Health-related quality of life: Validity, reliability, and responsiveness of SF-36, 15D, EQ-5D [corrected] RAQoL, and HAQ in patients with rheumatoid arthritis. J Rheumatol  2008; 35(8): 1528-37.
 [PMID: 18484697]

[31]
Van Vilsteren M, Boot CR, Knol DL, et al. Productivity at work and quality of life in patients with rheumatoid arthritis. BMC Musculoskelet Disord  2015; 16(1): 107.
 [http://dx.doi.org/10.1186/s12891-015-0562-x] [PMID: 25940578]

[32]
Van der Leeden M, Steultjens MP, Ursum J, et al. Prevalence and course of forefoot impairments and walking disability in the first eight years of rheumatoid arthritis. Arthritis Rheum  2008; 59(11): 1596-602.
 [http://dx.doi.org/10.1002/art.24188] [PMID: 18975350]

[33]
Bruce B, Fries JF. The stanford health assessment questionnaire: Dimensions and practical applications. Health Qual Life Outcomes  2003; 1: 20.
 [http://dx.doi.org/10.1186/1477-7525-1-20] [PMID: 12831398]

[34]
Sokka T, Krishnan E, Häkkinen A, Hannonen P. Functional disability in rheumatoid arthritis patients compared with a community population in Finland. Arthritis Rheum  2003; 48(1): 59-63.
 [http://dx.doi.org/10.1002/art.10731] [PMID: 12528104]

[35]
Callahan LF, Brooks RH, Summey JA, Pinkus T. Quantitative pain assessment for routine care of rheumatoid arthritis patients, using a pain scale based on activities of daily living and a visual analog scale. Arthritis Rheum  1987; 30: 630-6.

[36]
Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: Pathological mechanisms and modern pharmacologic therapies. Bone Res  2018; 6: 15.
 [http://dx.doi.org/10.1038/s41413-018-0016-9] [PMID: 29736302]

[37]
Dixey J, Solymossy C, Young A. Is it possible to predict radiological damage in early Rheumatoid Arthritis (RA)? A report on the occurrence, progression, and prognostic factors of radiological erosions over the first 3 years in 866 patients from the Early RA Study (ERAS). J Rheumatol Suppl  2004; 69: 48-54.
 [PMID: 15053454]

[38]
Hennessy K, Woodburn J, Steultjens M. Clinical practice guidelines for the foot and ankle in rheumatoid arthritis: A critical appraisal. J Foot Ankle Res  2016; 9(1): 31.
 [http://dx.doi.org/10.1186/s13047-016-0167-0] [PMID: 27547242]

[39]
Shi K, Tomita T, Hayashida K, Owaki H, Ochi T. Foot deformities in rheumatoid arthritis and relevance of disease severity. J Rheumatol  2000; 27(1): 84-9.
 [PMID: 10648022]

[40]
Wickman AM, Pinzur MS, Kadanoff R, Juknelis D. Health-related quality of life for patients with rheumatoid arthritis foot involvement. Foot Ankle Int  2004; 25(1): 19-26.
 [http://dx.doi.org/10.1177/107110070402500105] [PMID: 14768960]

[41]
Wilson O, Kirwan J, Dures E, Quest E, Hewlett S. The experience of foot problems and decisions to access foot care in patients with rheumatoid arthritis: A qualitative study. J Foot Ankle Res  2017; 10(4): 4.
 [http://dx.doi.org/10.1186/s13047-017-0188-3] [PMID: 28138340]

[42]
Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum  1980; 23(2): 137-45.
 [http://dx.doi.org/10.1002/art.1780230202] [PMID: 7362664]

[43]
Dubbeldam R, Nene AV, Buurke JH, et al. Foot and ankle joint kinematics in rheumatoid arthritis cannot only be explained by alteration in walking speed. Gait Posture  2011; 33(3): 390-5.
 [http://dx.doi.org/10.1016/j.gaitpost.2010.12.010] [PMID: 21295983]

[44]
Michelson J, Easley M, Wigley FM, Hellmann D. Foot and ankle problems in rheumatoid arthritis. Foot Ankle Int  1994; 15(11): 608-13.
 [http://dx.doi.org/10.1177/107110079401501106] [PMID: 7849976]

[45]
Güler H, Yildizgoren MT, Üstün N, et al. Relationship between foot pain/deformities and risk of fall in patients with rheumatoid arthritis. WIMJ Open  2015; 2(2): 81.

[46]
Böhler C, Radner H, Ernst M, et al. Rheumatoid arthritis and falls: The influence of disease activity. Rheumatology (Oxford)  2012; 51(11): 2051-7.
 [http://dx.doi.org/10.1093/rheumatology/kes198] [PMID: 22879462]

[47]
Yano K, Ikari K, Inoue E, et al. Features of patients with rheumatoid arthritis whose debut joint is a foot or ankle joint: A 5,479-case study from the IORRA cohort. PLoS One  2018; 13(9): e0202427.
 [http://dx.doi.org/10.1371/journal.pone.0202427] [PMID: 30188930]

[48]
Hulsmans HM, Jacobs JW, Van der Heijde DM, Van Albada-Kuipers GA, Schenk Y, Bijlsma JW. The course of radiologic damage during the first six years of rheumatoid arthritis. Arthritis Rheum  2000; 43(9): 1927-40.
 [http://dx.doi.org/10.1002/1529-0131(200009)43:9<1927::AID-ANR3>3.0.CO;2-B] [PMID: 11014342]

[49]
Welsing PM, Landewé RB, Van Riel PL, et al. The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: A longitudinal analysis. Arthritis Rheum  2004; 50(7): 2082-93.
 [http://dx.doi.org/10.1002/art.20350] [PMID: 15248205]

[50]
Baan H, Drossaers-Bakker W, Dubbeldam R, Van de Laar M. We should not forget the foot: Relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol  2011; 30(11): 1475-9.
 [http://dx.doi.org/10.1007/s10067-011-1780-8] [PMID: 21614474]

[51]
Van der Leeden M, Steultjens MP, Van Schaardenburg D, Dekker J. Forefoot disease activity in rheumatoid arthritis patients in remission: Results of a cohort study. Arthritis Res Ther  2010; 12(1): R3.
 [http://dx.doi.org/10.1186/ar2901] [PMID: 20055986]

[52]
Erickson AR, Candella AC, Mikuis TR. Clinical features in rheumatoid arthritisKelly and Firestein’s textbook of rheumatology Philadelphia:.  Elsevier 2016; pp. 1176-86.

[53]
Matricali GA, Boonen A, Verduyckt J, et al. The presence of forefoot problems and the role of surgery in patients with rheumatoid arthritis. Ann Rheum Dis  2006; 65(9): 1254-5.
 [http://dx.doi.org/10.1136/ard.2005.050823] [PMID: 16905588]

[54]
Otter SJ, Lucas K, Springett K, et al. Foot pain in rheumatoid arthritis prevalence, risk factors and management: An epidemiological study. Clin Rheumatol  2010; 29(3): 255-71.
 [http://dx.doi.org/10.1007/s10067-009-1312-y] [PMID: 19997766]

[55]
Grondal L, Tengstrand B, Nordmark B, Wretenberg P, Stark A. The foot: Still the most important reason for walking incapacity in rheumatoid arthritis: Distribution of symptomatic joints in 1,000 RA patients. Acta Orthop  2008; 79(2): 257-61.
 [http://dx.doi.org/10.1080/17453670710015067] [PMID: 18484253]

[56]
Naidoo S, Anderson S, Mills J, et al. “I could cry, the amount of shoes I can’t get into”: A qualitative exploration of the factors that influence retail footwear selection in women with rheumatoid arthritis. J Foot Ankle Res  2011; 4: 21.
 [http://dx.doi.org/10.1186/1757-1146-4-21] [PMID: 21794134]

[57]
Landewé R, van der Heijde D, van der Linden S, Boers M. Twenty-eight-joint counts invalidate the DAS28 remission definition owing to the omission of the lower extremity joints: A comparison with the original DAS remission. Ann Rheum Dis  2006; 65(5): 637-41.
 [http://dx.doi.org/10.1136/ard.2005.039859] [PMID: 16219709]

[58]
Firth J, Hale C, Helliwell P, Hill J, Nelson EA. The prevalence of foot ulceration in patients with rheumatoid arthritis. Arthritis Rheum  2008; 59(2): 200-5.
 [http://dx.doi.org/10.1002/art.23335] [PMID: 18240257]

[59]
Findlow AH, Nester CJ, Bowker P. Foot kinematics in patients with two patterns of pathological plantar hyperkeratosis. J Foot Ankle Res  2011; 4(1): 7.
 [http://dx.doi.org/10.1186/1757-1146-4-7] [PMID: 21306644]

[60]
Hooper L, Bowen CJ, Gates L, et al. Prognostic indicators of foot-related disability in patients with rheumatoid arthritis: Results of a prospective three-year study. Arthritis Care Res (Hoboken)  2012; 64(8): 1116-24.
 [PMID: 22422621]

[61]
Siddle HJ, Redmond AC, Waxman R, et al. Debridement of painful forefoot plantar callosities in rheumatoid arthritis: The CARROT randomised controlled trial. Clin Rheumatol  2013; 32(5): 567-74.
 [http://dx.doi.org/10.1007/s10067-012-2134-x] [PMID: 23247552]

[62]
Koller U, Willegger M, Windhager R, Wanivenhaus A, Trnka HJ, Schuh R. Plantar pressure characteristics in hallux valgus feet. J Orthop Res  2014; 32(12): 1688-93.
 [http://dx.doi.org/10.1002/jor.22707] [PMID: 25130961]

[63]
Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg Am  2011; 93(17): 1650-61.
 [http://dx.doi.org/10.2106/JBJS.H.01630] [PMID: 21915581]

[64]
Glasoe WM, Nuckley DJ, Ludewig PM. Hallux valgus and the first metatarsal arch segment: A theoretical biomechanical perspective. Phys Ther  2010; 90(1): 110-20.
 [http://dx.doi.org/10.2522/ptj.20080298] [PMID: 19926679]

[65]
Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev  2016; 1(8): 295-302.
 [http://dx.doi.org/10.1302/2058-5241.1.000005] [PMID: 28660074]

[66]
Wülker N, Mittag F. The treatment of hallux valgus. Dtsch Arztebl Int  2012; 109(49): 857-67.
 [PMID: 23267411]

[67]
Robinson AHN, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg Br  2005; 87(8): 1038-45.
 [http://dx.doi.org/10.1302/0301-620X.87B8.16467] [PMID: 16049235]

[68]
Galica AM, Hagedorn TJ, Dufour AB, et al. Hallux valgus and plantar pressure loading: The framingham foot study. J Foot Ankle Res  2013; 6(1): 42.
 [http://dx.doi.org/10.1186/1757-1146-6-42] [PMID: 24138804]

[69]
Van Der Leeden M, Steultjens M, Dekker JHM, Prins AP, Dekker J. The relationship of disease duration to foot function, pain and disability in rheumatoid arthritis patients with foot complaints. Clin Exp Rheumatol  2007; 25(2): 275-80.
 [PMID: 17543153]

[70]
Rojas VA, Bayona J, Zuluaga N, Mejia S, Hincapie ME, Anaya JM. The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis. BMC Musculoskelet Disord  2009; 10(1): 67.
 [http://dx.doi.org/10.1186/1471-2474-10-67] [PMID: 19527518]

[71]
Louwerens JWK, Schrier JC. Rheumatoid forefoot deformity: Pathophysiology, evaluation and operative treatment options. Int Orthop  2013; 37(9): 1719-29.
 [http://dx.doi.org/10.1007/s00264-013-2014-2] [PMID: 23892468]

[72]
Matsumoto T, Nakada I, Juji T, Nakamura I, Ito K. Radiologic patterning of hallux deformity in rheumatoid arthritis and its relationship to flatfoot. J Foot Ankle Surg  2016; 55(5): 948-54.
 [http://dx.doi.org/10.1053/j.jfas.2016.04.011] [PMID: 27289217]

[73]
Turner DE, Helliwell PS, Siegel KL, Woodburn J. Biomechanics of the foot in rheumatoid arthritis: Identifying abnormal function and the factors associated with localised disease ‘impact’. Clin Biomech  2008; 23(1): 93-100.
 [http://dx.doi.org/10.1016/j.clinbiomech.2007.08.009] [PMID: 17904711]

[74]
Van Der Leeden M, Steultjens M, Dekker JHM, Prins AP, Dekker J. Forefoot joint damage, pain and disability in rheumatoid arthritis patients with foot complaints: the role of plantar pressure and gait characteristics. Rheumatology (Oxford)  2006; 45(4): 465-9.
 [http://dx.doi.org/10.1093/rheumatology/kei186] [PMID: 16287922]

[75]
Tenten DM, Van Der Leeden M, Vliet VTPM, Dekker J. Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis. J Foot Ankle Res  2018; 11: 37.
 [http://dx.doi.org/10.1186/s13047-018-0276-z] [PMID: 29988776]

[76]
Walmsley S, Williams AE, Ravey M, Graham A. The rheumatoid foot: A systematic literature review of patient-reported outcome measures. J Foot Ankle Res  2010; 3(1): 12.
 [http://dx.doi.org/10.1186/1757-1146-3-12] [PMID: 20618927]

[77]
Wechalekar MD, Lester S, Hill CL, et al. Active foot synovitis in patients with rheumatoid arthritis: Unstable remission status, radiographic progression, and worse functional outcomes in patients with foot synovitis in apparent remission. Arthritis Care Res  2016; 68(11): 1616-23.
 [http://dx.doi.org/10.1002/acr.22887] [PMID: 26991415]

[78]
Graham AS, Stephenson J, Williams AE. A survey of people with foot problems related to rheumatoid arthritis and their educational needs. J Foot Ankle Res  2017; 10(1): 12.
 [http://dx.doi.org/10.1186/s13047-017-0193-6] [PMID: 28286569]
Cite As
Current Rheumatology Reviews

The Assessment of the Quality of Life in Patients with Rheumatoid Foot

Abstract

Graphical Abstract
