Grondal Lollo, Tengstrand Birgitta, Nordmark Birgitta, Wretenberg Per, Stark Andre
Department of Molecular Medicine and Surgery, Orthopedic Rehabilitation, Karolinska Institute, Red Cross Hospital, Stockholm, Sweden.
Acta Orthop. 2008 Apr;79(2):257-61. doi: 10.1080/17453670710015067.
Our knowledge of frequency of foot involvement in rheumatoid arthritis (RA) is still often based on a study from Finland in 1956. Great changes in the treatment of RA may have led to a different situation. We investigated the distribution of joint involvement in RA patients today, with special attention given to the feet and subjective walking ability.
1,000 RA patients answered a questionnaire concerning joints affected, joint surgery, foot problems, and subjectively experienced reasons for walking incapacity.
In 45% of the patients, the forefoot was involved at the start of the disease. In 17%, the hindfoot/ankle was involved at the start. Only hand symptoms were commoner. 80% of patients reported current foot problems, 86% in the forefoot and 52% in the hindfoot/ankle. Difficulty in walking due to the feet was reported by 71%. For 41% of patients, the foot was the most important part of the lower extremity causing reduced walking capacity, and for 32% it was the only part.
After the hand, the foot was the most frequently symptomatic joint complex at the start of the disease, but also during active medical treatment. The foot caused walking disability in three-quarters of the cases and-4 times as often as the knee or the hip-it was the only joint to subjectively impair gait.
我们对类风湿关节炎（RA）足部受累频率的认识仍常常基于1956年芬兰的一项研究。RA治疗方法的巨大变化可能导致了不同的情况。我们调查了如今RA患者关节受累的分布情况，特别关注足部以及主观行走能力。
1000名RA患者回答了一份关于受累关节、关节手术、足部问题以及主观体验到的行走能力丧失原因的问卷。
45%的患者在疾病初发时前足受累。17%的患者在初发时后足/踝关节受累。只有手部症状更为常见。80%的患者报告目前存在足部问题，前足为86%，后足/踝关节为52%。71%的患者报告因足部导致行走困难。对于41%的患者，足部是导致下肢行走能力下降的最重要部位，32%的患者认为足部是唯一导致行走能力下降的部位。
在疾病初发时以及积极治疗期间，足部是仅次于手部的最常出现症状的关节复合体。在四分之三的病例中，足部导致行走障碍，并且是主观上影响步态的唯一关节，其影响频率是膝关节或髋关节的4倍。
