Background Patients with rheumatoid arthritis (RA) commonly report problems with their feet.1 It is known that foot joint involvement begins early in the course of RA and even patients on biologic therapy and/or with low disease activity can still experience high levels of foot pain.1–3 Current UK guidance states that “All people with RA and foot problems should have access to a podiatrist for assessment and periodic review of their foot health needs”.4
Objectives To understand how foot health problems affect patients with RA.
Methods Adult patients, with a diagnosis of rheumatoid arthritis and ability to converse in English, were recruited by clinicians based at a London hospital rheumatology outpatient clinic to participate in two focus groups on foot health. These were conducted by the lead patient researcher and comprised 8 females and 1 male of diverse ethnicities, aged 27–68 years old with 4–46 years disease duration. The focus groups were audio-recorded and transcribed verbatim. Transcripts were verified for authenticity by a random sample of 4 participants, and were systematically coded with the assistance of qualitative data analysis computer software. Themes were generated and cross-checked by the co-researcher to negate any potential bias by the lead patient researcher.
Results Four interlinked themes were identified: 1) dependence on feet, e.g. needed for standing and walking; 2) physical impact e.g. pain, swelling and deformities; 3) social impact e.g. hard to keep appointments and participate in leisure activities; 4) psychological impact e.g. low self-esteem, worry and using humour to cope. The sole male participant was unaffected by theme 4. One patient in the group had not experienced foot problems since diagnosis. No differences were identified across age, ethnicity or disease duration.
Conclusions Foot problems can significantly lower quality of life for patients with RA. It is therefore essential that foot health is adequately addressed during rheumatology outpatient consultations with onward referral to podiatry services as necessary.
Grondal et al. The foot: still the most important reason for walking incapacity in rheumatoid arthritis: distribution of symptomatic joints in 1,000 RA patients. Acta Orthopaedica. 2008;79:257–61.
Otter et al. Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFα therapy: an epidemiological study. Rheumatol Int. 2011;31:1515–9.
van der Leeden et al. Prevalence and course of forefoot impairments and walking disability in the first eight years of rheumatoid arthritis. Arthritis Rheum. 2008;59:1596–602.
National Institute for Health and Care Excellence. Clinical Guideline 79, Rheumatoid arthritis: the management of rheumatoid arthritis in adults. 2009.
Acknowledgements We thank James Galloway and Carron Congreve for patient recruitment, Patience Duffort for transcription services and the patient participants for sharing their experiences.
Disclosure of Interest None declared
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