Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy

<p>Abstract</p> <p>Background</p> <p>Inhibition of tumour necrosis factor <b>(</b>TNF) is an effective way of reducing synovitis and preventing joint damage in rheumatoid arthritis (RA), yet very little is known about its specific effect on foot pain and dis...

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Main Authors: Dewbury Keith, Hooper Lindsey, Edwards Christopher J, Bowen Catherine J, Sampson Madeleine, Sawyer Sally, Burridge Jane, Arden Nigel K
Format: Article
Language:English
Published: BMC 2010-06-01
Series:Journal of Foot and Ankle Research
Online Access:http://www.jfootankleres.com/content/3/1/10
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spelling doaj-71230ba3b85a4d3aa45ec93e89466d742020-11-24T21:09:57ZengBMCJournal of Foot and Ankle Research1757-11462010-06-01311010.1186/1757-1146-3-10Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapyDewbury KeithHooper LindseyEdwards Christopher JBowen Catherine JSampson MadeleineSawyer SallyBurridge JaneArden Nigel K<p>Abstract</p> <p>Background</p> <p>Inhibition of tumour necrosis factor <b>(</b>TNF) is an effective way of reducing synovitis and preventing joint damage in rheumatoid arthritis (RA), yet very little is known about its specific effect on foot pain and disability. The aim of this study was to evaluate whether anti-TNF therapy alters the presence of forefoot pathology and/or reduces foot pain and disability.</p> <p>Methods</p> <p>Consecutive RA patients starting anti-TNF therapy (infliximab, etanercept, adalimumab) were assessed for presence of synovial hypertrophy and synovitis in the 2<sup>nd </sup>and 5<sup>th </sup>metatarso-phalangeal (MTP) joints and plantar forefoot bursal hypertrophy before and 12 weeks after therapy. Tender MTP joints and swollen bursae were established clinically by an experienced podiatrist and ultrasound (US) images were acquired and interpreted by a radiologist. Assessment of patient reported disease impact on the foot was performed using the Manchester Foot Pain and Disability Index (MFPDI).</p> <p>Results</p> <p>31 patients (24 female, 7 male) with RA (12 seronegative, 19 seropositive) completed the study: mean age 59.6 (SD 10.1) years, disease duration 11.1 (SD 10.5) years, and previous number of Disease Modifying Anti Rheumatic Drugs 3.0 (1.6). Significant differences after therapy were found for Erythrocyte Sedimentation Rate (t = 4.014, p < 0.001), C-reactive protein (t = 3.889, p = 0.001), 28 joint Disease Activity Score (t = 3.712, p = 0.0001), Visual Analog Scale (t = 2.735, p = 0.011) and Manchester Foot Pain and Disability Index (t = 3.712, p = 0.001).</p> <p>Presence of MTP joint synovial hypertrophy on US was noted in 67.5% of joints at baseline and 54.8% of joints at twelve weeks. Presence of plantar forefoot bursal hypertrophy on US was noted in 83.3% of feet at baseline and 75% at twelve weeks. Although there was a trend for reduction in observed presence of person specific forefoot pathology, when the frequencies were analysed (McNemar) this was not significant.</p> <p>Conclusions</p> <p>Significant improvements were seen in patient reported foot pain and disability 12 weeks after commencing TNF inhibition in RA, but this may not be enough time to detect changes in forefoot pathology.</p> http://www.jfootankleres.com/content/3/1/10
collection DOAJ
language English
format Article
sources DOAJ
author Dewbury Keith
Hooper Lindsey
Edwards Christopher J
Bowen Catherine J
Sampson Madeleine
Sawyer Sally
Burridge Jane
Arden Nigel K
spellingShingle Dewbury Keith
Hooper Lindsey
Edwards Christopher J
Bowen Catherine J
Sampson Madeleine
Sawyer Sally
Burridge Jane
Arden Nigel K
Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy
Journal of Foot and Ankle Research
author_facet Dewbury Keith
Hooper Lindsey
Edwards Christopher J
Bowen Catherine J
Sampson Madeleine
Sawyer Sally
Burridge Jane
Arden Nigel K
author_sort Dewbury Keith
title Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy
title_short Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy
title_full Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy
title_fullStr Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy
title_full_unstemmed Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy
title_sort improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-tnf therapy
publisher BMC
series Journal of Foot and Ankle Research
issn 1757-1146
publishDate 2010-06-01
description <p>Abstract</p> <p>Background</p> <p>Inhibition of tumour necrosis factor <b>(</b>TNF) is an effective way of reducing synovitis and preventing joint damage in rheumatoid arthritis (RA), yet very little is known about its specific effect on foot pain and disability. The aim of this study was to evaluate whether anti-TNF therapy alters the presence of forefoot pathology and/or reduces foot pain and disability.</p> <p>Methods</p> <p>Consecutive RA patients starting anti-TNF therapy (infliximab, etanercept, adalimumab) were assessed for presence of synovial hypertrophy and synovitis in the 2<sup>nd </sup>and 5<sup>th </sup>metatarso-phalangeal (MTP) joints and plantar forefoot bursal hypertrophy before and 12 weeks after therapy. Tender MTP joints and swollen bursae were established clinically by an experienced podiatrist and ultrasound (US) images were acquired and interpreted by a radiologist. Assessment of patient reported disease impact on the foot was performed using the Manchester Foot Pain and Disability Index (MFPDI).</p> <p>Results</p> <p>31 patients (24 female, 7 male) with RA (12 seronegative, 19 seropositive) completed the study: mean age 59.6 (SD 10.1) years, disease duration 11.1 (SD 10.5) years, and previous number of Disease Modifying Anti Rheumatic Drugs 3.0 (1.6). Significant differences after therapy were found for Erythrocyte Sedimentation Rate (t = 4.014, p < 0.001), C-reactive protein (t = 3.889, p = 0.001), 28 joint Disease Activity Score (t = 3.712, p = 0.0001), Visual Analog Scale (t = 2.735, p = 0.011) and Manchester Foot Pain and Disability Index (t = 3.712, p = 0.001).</p> <p>Presence of MTP joint synovial hypertrophy on US was noted in 67.5% of joints at baseline and 54.8% of joints at twelve weeks. Presence of plantar forefoot bursal hypertrophy on US was noted in 83.3% of feet at baseline and 75% at twelve weeks. Although there was a trend for reduction in observed presence of person specific forefoot pathology, when the frequencies were analysed (McNemar) this was not significant.</p> <p>Conclusions</p> <p>Significant improvements were seen in patient reported foot pain and disability 12 weeks after commencing TNF inhibition in RA, but this may not be enough time to detect changes in forefoot pathology.</p>
url http://www.jfootankleres.com/content/3/1/10
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