Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: A twelve‐month investigation
- 30 November 2010
- journal article
- research article
- Published by Wiley in Arthritis Care & Research
- Vol. 62 (12), 1756-1762
- https://doi.org/10.1002/acr.20326
Abstract
Objective To determine the natural history and clinical significance of forefoot bursae over a 12‐month period in patients with rheumatoid arthritis (RA). Methods Patients with RA (n = 149) attending rheumatology outpatient clinics were assessed at baseline. A total of 120 participants, mean ± SD age 60.7 ± 12.1 years and mean ± SD disease duration 12.99 ± 10.4 years, completed the 12‐month followup (98 women, 22 men, 93 rheumatoid factor positive, 24 rheumatoid factor negative, and 3 unknown). Musculoskeletal ultrasound (US) was used to identify forefoot bursae in all of the participants. Clinical markers of disease activity (well‐being visual analog scale [VAS], erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP] level, and Disease Activity Score in 28 joints [DAS28]) and foot symptoms on the Leeds Foot Impact Scale (LFIS) Questionnaire were recorded on both occasions. Results Presence of US‐detectable forefoot bursae was identified in 93.3% of returnee (n = 120) participants (individual mean 3.7, range 0–11) at baseline. Significant associations were identified between bursae presence and patient‐reported foot impact for impairment/footwear (LFISIF; baseline: r = 0.226, P = 0.013 and 12 months: r = 0.236, P = 0.009) and activity limitation/participation restriction (LFISAP; baseline: r = 0.254, P = 0.005 and 12 months: r = 0.235, P = 0.010). After 12 months, 42.5% of participants had an increase in the number of US‐detectable forefoot bursae and 45% of participants had a decrease. Changes in bursae number significantly correlated with changes in LFISIF (r = 0.216, P = 0.018) and LFISAP (r = 0.193, P = 0.036). No significant associations were identified between changes in bursae and changes in global well‐being VAS, ESR, CRP level, or DAS28. Conclusion The findings of this study suggest that forefoot bursae may regress or hypertrophy over time in patients with RA, and that these changes may be associated with self‐reported foot impairment and activity restriction.This publication has 29 references indexed in Scilit:
- The clinical importance of ultrasound detectable forefoot bursae in rheumatoid arthritisRheumatology, 2009
- A systematic review of instruments measuring foot function, foot pain, and foot‐related disability in patients with rheumatoid arthritisArthritis Care & Research, 2008
- Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter‐observer agreement between a podiatrist and a radiologistJournal of Foot and Ankle Research, 2008
- Level of radiographic damage and radiographic progression are determinants of physical function: a longitudinal analysis of the TEMPO trialAnnals Of The Rheumatic Diseases, 2007
- Ultrasonographic and radiographic results from a two‐year controlled trial of immediate or one‐year–delayed addition of infliximab to ongoing methotrexate therapy in patients with erosive early rheumatoid arthritisArthritis & Rheumatism, 2005
- The smallest detectable difference and sensitivity to change of magnetic resonance imaging and radiographic scoring of structural joint damage in rheumatoid arthritis finger, wrist, and toe joints: A comparison of the omeract rheumatoid arthritis magnetic resonance imaging score applied to different joint combinations and the sharp/van der heijde radiographic scoreArthritis & Rheumatism, 2005
- Development of a foot impact scale for rheumatoid arthritisArthritis & Rheumatism, 2005
- Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonographyAnnals Of The Rheumatic Diseases, 2004
- Involvement of an inconstant bursa under the head of the second metatarsal bone in spondyloarthritisClinical Rheumatology, 2004
- The american rheumatism association 1987 revised criteria for the classification of rheumatoid arthritisArthritis & Rheumatism, 1988