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|a Objective: To determine the prevalence and natural history of foot-related disability in patients with RA. A secondary aim was to identify explanatory variables, including forefoot bursae, which are either associated with or predictive of disabling foot complications in patients with RA. Methods: A longitudinal, prospective, cohort study recruited patients with RA from a rheumatology outpatient clinic. Data were collected at baseline (N=149), one-year (n=120) and three-year follow-up (n=60). Patient-reported disabling foot complications were evaluated using the subscales of the Foot Impairment Score; foot impairment/ footwear restriction (FISIF) & activity limitation/participation restriction (FISAP). Explanatory variables investigated included ultrasound detectable forefoot pathology and markers of disease activity. Results: Disabling foot complications were highly prevalent on all occasions. Changes in foot impairment and activity limitation were significantly associated with fluctuations in disease activity (FISIF: DAS28-ESR r=0.455, p<0.0001; ESR r=-0.356, p=0.008, FISAP: DAS28-ESR r=0.433, p=0.001; ESR r=-0.439, p=0.001), and approaching a significant association with changes in forefoot bursae (FISIF: r=0.255, p=0.063; FISAP: r=0.255, p=0.063). Disease duration and forefoot bursae presence were significant prognostic indicators of foot impairment (p=0.009, p=0.012 respectively), explaining 16% of score variability in the final regression model. Disease duration, forefoot bursae and erosion presence were identified as significant prognostic indicators of activity limitation (p=0.006, p=0.019, p=0.002 respectively), explaining 35% of score variability in the final regression model. Conclusion: Despite advances in disease management, patients report disability associated with foot problems. Forefoot bursae should be considered for targeted therapy
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