The prevalence of foot ulceration in patients with rheumatoid arthritis

OBJECTIVES:

To establish the prevalence of foot ulceration in patients with rheumatoid arthritis (RA) in secondary care.

METHODS:

A postal survey of all the patients with RA under the care of rheumatologists in Bradford, West Yorkshire (n=1130) was undertaken. The prevalence data were validated through clinical examination, case note review and contact with health professionals. The false negative rate was investigated in a sub-sample of patients (n=70) who denied any history of ulceration.

RESULTS:

The postal survey achieved a 78% response rate. Following validation, the point prevalence of foot ulceration was 3.39% and the overall prevalence 9.73%. The false positive rate was initially high at 21.21%, but use of diagrammatic questionnaire data to exclude leg ulceration reduced this to 10.76%. The false negative rate was 11.76%. The most common sites for ulceration were the dorsal aspect of hammer toes, the metatarsal heads and hallux valgus, with 33% of patients reporting multiple sites of ulceration. Patients with open and healed foot ulceration had significantly longer RA disease duration than ulcer free patients, reported significantly greater usage of special footwear and a higher prevalence of foot surgery.

CONCLUSIONS:

Foot ulceration affects a significant proportion of patients with RA. Further work is needed to establish risk factors for foot ulceration in RA and to target foot health provision more effectively.