Foot problems in rheumatoid arthritis (RA); under-rated, under-assessed & under-referred?

Background: Foot pathology is thought to be common in in RA and the role of the podiatrist in the multidisciplinary care team is well established. Yet, recent reports suggest there is a shortfall between the need for foot health services and serviceprovision for people with RA. We set out to determine the effectiveness of
assessment of foot involvement among patients with RA.
Methods: A 28-item postal questionnaire consisting of open and closed questions was posted to all RA patients registered with the National rheumatoid Arthritis (NRAS) database. The questionnaire enquired about the occurrence of foot symptoms, the availability of podiatric services and the usefulness of interventions in foot symptoms and function.
Results: In total, 650 patients with Rheumatoid Arthritis were contacted. Of them, 395 (61%) responded. From the responses 93% of people reported unremitting, moderate to severe foot pain on a daily basis. 87% of respondents had reported their foot complaints to their rheumatologist amongst whom 64% had been referred to a podiatrist. On average patients reported their hands were examined at least once every 5.8 months, whereas their feet were examined once every 13.8 months. Patients generally felt that foot pain was a major aspect of their disease: ‘my entire being is focussed on my feet, if it were not for my feet I could cope’ and some felt their foot pathologies were sometimes dismissed ‘‘medics trivialize foot problems’’.
Conclusions: We suggest outcome measures that do not include the feet, such as
the DAS28 may discourage foot examination. Rheumatologists and podiatrists
need to work more closely together to develop a comprehensive foot care service to address the needs of people with RA.