Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: a twelve-month investigation

• Main Authors: Bowen, Catherine J. (Author), Hooper, Lindsey (Author), Culliford, David (Author), Dewbury, Keith (Author), Sampson, Madeline (Author), Burridge, Jane (Author), Edwards, Christopher J. (Author), Arden, Nigel K. (Author)
• Format: Article
• Language: English
• Published: 2010.
• Subjects: Article
• Online Access: Get fulltext

 Objective: To determine the natural history and clinical significance of forefoot bursae over a 12-month period in patients with rheumatoid arthritis (RA). Methods: Patients with RA (n = 149) attending rheumatology outpatient clinics were assessed at baseline. A total of 120 participants, mean ± SD age 60.7 ± 12.1 years and mean ± SD disease duration 12.99 ± 10.4 years, completed the 12-month followup (98 women, 22 men, 93 rheumatoid factor positive, 24 rheumatoid factor negative, and 3 unknown). Musculoskeletal ultrasound (US) was used to identify forefoot bursae in all of the participants. Clinical markers of disease activity (well-being visual analog scale [VAS], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] level, and Disease Activity Score in 28 joints [DAS28]) and foot symptoms on the Leeds Foot Impact Scale (LFIS) Questionnaire were recorded on both occasions. Results: Presence of US-detectable forefoot bursae was identified in 93.3% of returnee (n = 120) participants (individual mean 3.7, range 0-11) at baseline. Significant associations were identified between bursae presence and patient-reported foot impact for impairment/footwear (LFISIF; baseline: r = 0.226, P = 0.013 and 12 months: r = 0.236, P = 0.009) and activity limitation/participation restriction (LFISAP; baseline: r = 0.254, P = 0.005 and 12 months: r = 0.235, P = 0.010). After 12 months, 42.5% of participants had an increase in the number of US-detectable forefoot bursae and 45% of participants had a decrease. Changes in bursae number significantly correlated with changes in LFISIF (r = 0.216, P = 0.018) and LFISAP (r = 0.193, P = 0.036). No significant associations were identified between changes in bursae and changes in global well-being VAS, ESR, CRP level, or DAS28. Conclusion: The findings of this study suggest that forefoot bursae may regress or hypertrophy over time in patients with RA, and that these changes may be associated with self-reported foot impairment and activity restriction.