Transcript The Leeds Dactylitis Index An objective outcome measure

The Prevalence of Foot Ulceration in Rheumatoid Arthritis
Jill Firth1, Claire Hale1, Philip Helliwell2 and Jackie Hill1
1Academic Unit of Musculoskeletal Nursing, University of Leeds, 2Academic
1 Background
Foot ulceration is thought to be a common problem in
people with rheumatoid arthritis (RA) but little research has
been undertaken in this area.
2 Aims
• To establish the prevalence of foot ulceration in patients
with RA in a single secondary care setting
• To describe the clinical characteristics of affected
patients.
Table 1 Baseline characteristics of respondents
Variable
Result
Sex F: M (%)
641:240 (73%)
Mean age (range)
63 years (20-94)
Mean disease duration
(range)
Ethnicity (%)
15 years (1-65)
785 (89%) white british; 44 (5%)
pakistani; 22 (3%) indian.
3 Methods
• A foot ulcer was defined as an open sore or wound
below the ankle which takes over 2 weeks to heal
50
• All patients with RA under review by consultant
rheumatologists in Bradford, West Yorkshire were sent a
postal questionnaire to establish overall and point
prevalence (n=1130)
40
• A validation phase to this study is in progress.
30
60
open cases
healed cases
false positives
26
22
20
10
• The response rate was 78% following one reminder.
Baseline sample characteristics are shown in table 1.
• The prevalence data is displayed in Figure 1. Adjusting
for false positives, the overall prevalence of foot ulceration
was 10% and the point prevalence 3%. If diabetic patients
are excluded from the analysis, the prevalence of
ulceration in RA is unchanged.
• 49 patients (57%) reported ulceration occurring on the
toes; 53 (62%) on the forefoot; 27 (31%) on the rearfoot.
• 45 patients (52%) reported multiple episodes of ulceration
ranging from 2-30 (median 2.00; IQR 1-4).
• The differences between open cases, healed cases and
ulcer free patients are shown in table 2.
Open cases Healed cases No ulcer
n = 26
n = 60
n = 763
Χ2 test
(p value)
Mean age
(SD)
59.2 (16.6)
62.7 (13.4)
62.7 (12.9)
KW 1.28
(ns)
Sex M:F
(% female)
7 : 19 (73%)
11 : 49 (83%)
212 : 551 (72%) 2.52
(ns)
18.9 years
(13.2)
14.1 years
(10.9)
KW 12.9
(0.002)
Podiatry
14 / 26 (54%) 36 / 58 (61%)
within past 12
months (%)
350 / 743 (47%) 6.6
(ns)
Wearing
special
footwear (%)
12 / 26 (46%) 34 / 60 (57%)
265 / 755 (35%) 12.06
(0.002)
Wearing
prescribed
insoles (%)
12 / 25 (48%) 23 / 60 (38%)
250 / 753 (33%) 2.9
(ns)
Previous foot
surgery (%)
7 / 26 (27%)
127 / 760 (17%) 23.9
(0.0001)
25 / 60 (42%)
6 Conclusions
0
4 Results
Table 2 Differences between the groups
Mean disease 19 years
duration (SD) (14.0)
Figure 1 - Prevalence data
60
• Respondents were classified as false positives where
diagrammatic questionnaire data indicated leg rather
than foot ulceration
Unit of Musculoskeletal Disease, University of Leeds West Yorkshire, UK
No of cases
• 10% of RA patients in a single secondary care setting reported a
history of foot ulceration.
• 3% reported open ulceration at the time of the study.
Figure 2 – Common sites for ulceration
• This prevalence data is currently in the process of being validated.
• Patients with open or healed foot ulceration had longer disease
duration, reported greater use of special footwear and a higher
prevalence of past foot surgery.
• The recurrent nature of this problem indicates that further work is
needed to establish risk factors for foot ulceration in RA and to target
foot health provision more effectively.
Acknowledgements
Jill Firth is funded by a Smith & Nephew Foundation Doctoral
Scholarship