The predictors of foot ulceration in patients with rheumatoid arthritis

Jill Firth; Robin Waxman; Graham Law; E.A. Nelson; Philip Helliwell; Heidi Siddle; Simon Otter; Violet Butters; Lesley Baker; Rosemary Hryniw; Sarah Bradley; Lorraine Loughrey; Begonya Alcacer-Pitarch; Samantha Davies; Jennifer Tranter

doi:10.1007/s10067-013-2428-7

The predictors of foot ulceration in patients with rheumatoid arthritis

Jill Firth, Robin Waxman, Graham Law, E.A. Nelson, Philip Helliwell, Heidi Siddle, Simon Otter, Violet Butters, Lesley Baker, Rosemary Hryniw, Sarah Bradley, Lorraine Loughrey, Begonya Alcacer-Pitarch, Samantha Davies, Jennifer Tranter

Research output: Contribution to journal › Article

Abstract

This study was conducted to determine the predictorsof foot ulceration occurring in patients with rheumatoidarthritis (RA) without diabetes. A multi-centre case controlstudy was undertaken; participants were recruited from eightsites (UK). Cases were adults diagnosed with RA (withoutdiabetes) and the presence of a validated foot ulcer, defined asa full thickness skin defect occurring in isolation on / belowthe midline of the malleoli and requiring > 14 days to heal.Controls met the same criteria but were ulcer naive. Clinicalexamination included loss of sensation (10g monofilament, ankle-brachial pressure index (ABPI); forefoot deformity(Platto); plantar pressures (PressureStat); RA disease activity(36 swollen/tender joint counts) and the presence of vasculitis.History taking included past ulceration/foot surgery; currentmedication and smoking status. Participants completed theHealth Assessment Questionnaire (HAQ) and Foot Impact Scale.A total of 83 cases with 112 current ulcers and 190 ulcer naïvecontrols participated. Cases were significantly older (mean age71 years; 95 % confidence interval [CI], 69–73 vs. 62 years, 60–64) and had longer RA disease duration (mean 22 years; 19–25vs. 15, 13–17). Univariate analysis showed that risk of ulcerationincreases with loss of sensation; abnormality of ABPI and footdeformity. Plantar pressures and joint counts were not significantpredictors. HAQ score and history of foot surgery were stronglyassociated with ulceration (odds ratio [OR]=1.704, 95 % CI1.274–2.280 andOR=2.256, 95%CI 1.294–3.932). Three casesand two controls presented with suspected cutaneous vasculitis.In logistic regression modelling, ABPI (OR=0.04; 95 % CI,0.01–0.28) forefoot deformity (OR=1.14; 95 % CI, 1.08–1.21)and loss of sensation (OR=1.22; 95 % CI, 1.10–1.36) predictedrisk of ulceration. In patients with RA, ABPI, forefoot deformityand loss of sensation predict risk of ulceration but, in contrastwith diabetes, raised plantar pressures do not predict risk.

Original language	English
Pages (from-to)	615-621
Number of pages	7
Journal	Clinical Rheumatology
Volume	33
Issue number	5
DOIs	https://doi.org/10.1007/s10067-013-2428-7
Publication status	Published - 31 May 2014

Keywords

Foot ulceration
Predictors
Rheumatoid arthritis

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Simon Otter

S.Otter@brighton.ac.uk

School of Health Sciences - Principal Lecturer
Centre for Regenerative Medicine and Devices

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Cite this

Firth, J., Waxman, R., Law, G., Nelson, E. A., Helliwell, P., Siddle, H., Otter, S., Butters, V., Baker, L., Hryniw, R., Bradley, S., Loughrey, L., Alcacer-Pitarch, B., Davies, S., & Tranter, J. (2014). The predictors of foot ulceration in patients with rheumatoid arthritis. Clinical Rheumatology, 33(5), 615-621. https://doi.org/10.1007/s10067-013-2428-7

Firth, Jill ; Waxman, Robin ; Law, Graham ; Nelson, E.A. ; Helliwell, Philip ; Siddle, Heidi ; Otter, Simon ; Butters, Violet ; Baker, Lesley ; Hryniw, Rosemary ; Bradley, Sarah ; Loughrey, Lorraine ; Alcacer-Pitarch, Begonya ; Davies, Samantha ; Tranter, Jennifer. / The predictors of foot ulceration in patients with rheumatoid arthritis. In: Clinical Rheumatology. 2014 ; Vol. 33, No. 5. pp. 615-621.

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abstract = "This study was conducted to determine the predictorsof foot ulceration occurring in patients with rheumatoidarthritis (RA) without diabetes. A multi-centre case controlstudy was undertaken; participants were recruited from eightsites (UK). Cases were adults diagnosed with RA (withoutdiabetes) and the presence of a validated foot ulcer, defined asa full thickness skin defect occurring in isolation on / belowthe midline of the malleoli and requiring > 14 days to heal.Controls met the same criteria but were ulcer naive. Clinicalexamination included loss of sensation (10g monofilament, ankle-brachial pressure index (ABPI); forefoot deformity(Platto); plantar pressures (PressureStat); RA disease activity(36 swollen/tender joint counts) and the presence of vasculitis.History taking included past ulceration/foot surgery; currentmedication and smoking status. Participants completed theHealth Assessment Questionnaire (HAQ) and Foot Impact Scale.A total of 83 cases with 112 current ulcers and 190 ulcer na{\"i}vecontrols participated. Cases were significantly older (mean age71 years; 95 % confidence interval [CI], 69–73 vs. 62 years, 60–64) and had longer RA disease duration (mean 22 years; 19–25vs. 15, 13–17). Univariate analysis showed that risk of ulcerationincreases with loss of sensation; abnormality of ABPI and footdeformity. Plantar pressures and joint counts were not significantpredictors. HAQ score and history of foot surgery were stronglyassociated with ulceration (odds ratio [OR]=1.704, 95 % CI1.274–2.280 andOR=2.256, 95%CI 1.294–3.932). Three casesand two controls presented with suspected cutaneous vasculitis.In logistic regression modelling, ABPI (OR=0.04; 95 % CI,0.01–0.28) forefoot deformity (OR=1.14; 95 % CI, 1.08–1.21)and loss of sensation (OR=1.22; 95 % CI, 1.10–1.36) predictedrisk of ulceration. In patients with RA, ABPI, forefoot deformityand loss of sensation predict risk of ulceration but, in contrastwith diabetes, raised plantar pressures do not predict risk.",

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The predictors of foot ulceration in patients with rheumatoid arthritis. / Firth, Jill; Waxman, Robin; Law, Graham; Nelson, E.A.; Helliwell, Philip; Siddle, Heidi; Otter, Simon; Butters, Violet; Baker, Lesley; Hryniw, Rosemary; Bradley, Sarah; Loughrey, Lorraine; Alcacer-Pitarch, Begonya; Davies, Samantha; Tranter, Jennifer.

In: Clinical Rheumatology, Vol. 33, No. 5, 31.05.2014, p. 615-621.

Research output: Contribution to journal › Article

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T1 - The predictors of foot ulceration in patients with rheumatoid arthritis

AU - Firth, Jill

AU - Waxman, Robin

AU - Law, Graham

AU - Nelson, E.A.

AU - Helliwell, Philip

AU - Siddle, Heidi

AU - Otter, Simon

AU - Butters, Violet

AU - Baker, Lesley

AU - Hryniw, Rosemary

AU - Bradley, Sarah

AU - Loughrey, Lorraine

AU - Alcacer-Pitarch, Begonya

AU - Davies, Samantha

AU - Tranter, Jennifer

PY - 2014/5/31

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N2 - This study was conducted to determine the predictorsof foot ulceration occurring in patients with rheumatoidarthritis (RA) without diabetes. A multi-centre case controlstudy was undertaken; participants were recruited from eightsites (UK). Cases were adults diagnosed with RA (withoutdiabetes) and the presence of a validated foot ulcer, defined asa full thickness skin defect occurring in isolation on / belowthe midline of the malleoli and requiring > 14 days to heal.Controls met the same criteria but were ulcer naive. Clinicalexamination included loss of sensation (10g monofilament, ankle-brachial pressure index (ABPI); forefoot deformity(Platto); plantar pressures (PressureStat); RA disease activity(36 swollen/tender joint counts) and the presence of vasculitis.History taking included past ulceration/foot surgery; currentmedication and smoking status. Participants completed theHealth Assessment Questionnaire (HAQ) and Foot Impact Scale.A total of 83 cases with 112 current ulcers and 190 ulcer naïvecontrols participated. Cases were significantly older (mean age71 years; 95 % confidence interval [CI], 69–73 vs. 62 years, 60–64) and had longer RA disease duration (mean 22 years; 19–25vs. 15, 13–17). Univariate analysis showed that risk of ulcerationincreases with loss of sensation; abnormality of ABPI and footdeformity. Plantar pressures and joint counts were not significantpredictors. HAQ score and history of foot surgery were stronglyassociated with ulceration (odds ratio [OR]=1.704, 95 % CI1.274–2.280 andOR=2.256, 95%CI 1.294–3.932). Three casesand two controls presented with suspected cutaneous vasculitis.In logistic regression modelling, ABPI (OR=0.04; 95 % CI,0.01–0.28) forefoot deformity (OR=1.14; 95 % CI, 1.08–1.21)and loss of sensation (OR=1.22; 95 % CI, 1.10–1.36) predictedrisk of ulceration. In patients with RA, ABPI, forefoot deformityand loss of sensation predict risk of ulceration but, in contrastwith diabetes, raised plantar pressures do not predict risk.

AB - This study was conducted to determine the predictorsof foot ulceration occurring in patients with rheumatoidarthritis (RA) without diabetes. A multi-centre case controlstudy was undertaken; participants were recruited from eightsites (UK). Cases were adults diagnosed with RA (withoutdiabetes) and the presence of a validated foot ulcer, defined asa full thickness skin defect occurring in isolation on / belowthe midline of the malleoli and requiring > 14 days to heal.Controls met the same criteria but were ulcer naive. Clinicalexamination included loss of sensation (10g monofilament, ankle-brachial pressure index (ABPI); forefoot deformity(Platto); plantar pressures (PressureStat); RA disease activity(36 swollen/tender joint counts) and the presence of vasculitis.History taking included past ulceration/foot surgery; currentmedication and smoking status. Participants completed theHealth Assessment Questionnaire (HAQ) and Foot Impact Scale.A total of 83 cases with 112 current ulcers and 190 ulcer naïvecontrols participated. Cases were significantly older (mean age71 years; 95 % confidence interval [CI], 69–73 vs. 62 years, 60–64) and had longer RA disease duration (mean 22 years; 19–25vs. 15, 13–17). Univariate analysis showed that risk of ulcerationincreases with loss of sensation; abnormality of ABPI and footdeformity. Plantar pressures and joint counts were not significantpredictors. HAQ score and history of foot surgery were stronglyassociated with ulceration (odds ratio [OR]=1.704, 95 % CI1.274–2.280 andOR=2.256, 95%CI 1.294–3.932). Three casesand two controls presented with suspected cutaneous vasculitis.In logistic regression modelling, ABPI (OR=0.04; 95 % CI,0.01–0.28) forefoot deformity (OR=1.14; 95 % CI, 1.08–1.21)and loss of sensation (OR=1.22; 95 % CI, 1.10–1.36) predictedrisk of ulceration. In patients with RA, ABPI, forefoot deformityand loss of sensation predict risk of ulceration but, in contrastwith diabetes, raised plantar pressures do not predict risk.

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KW - Predictors

KW - Rheumatoid arthritis

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DO - 10.1007/s10067-013-2428-7

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JO - Clinical Rheumatology

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SN - 0770-3198

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