Wilson Oonagh, Hewlett Sarah, Woodburn James, Pollock Jon, Kirwan John
Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
J Foot Ankle Res. 2017 Oct 27;10:46. doi: 10.1186/s13047-017-0229-y. eCollection 2017.
Foot symptoms in rheumatoid arthritis (RA) derive from a combination of inflammation, altered foot mechanics, deformity and secondary skin lesions. Guidelines recommend regular review of patients' feet, but the extent to which the general population of RA patients report foot symptoms and access foot care has not been established. The aims of this study were to determine the prevalence, impact and care of foot problems in all patients with RA in one geographical area and identify factors associated with accessing foot care.
Cross-sectional survey of a random sample of patients with RA, who resided within a single community-based National Health Service (NHS) podiatry service. The questionnaire collected demographic data (age, gender, local deprivation score), clinical data (disease duration, arthritis medications, disability (Health Assessment Questionnaire (HAQ)), current foot problems, foot care accessed (podiatry, orthotics and/or orthopaedics) and care received, measures of impact (Foot Impact Scale) and ability to work.
Of 1003 total eligible patients in the target population, 739 were posted survey packs. Of these 413 (56%) replied. Responders and non-responders had similar age (63.5 yr. vs.61.5 yr), gender (74.1%F vs. 75.2%F), and highest deprivation category (13.3% vs.15.9%). Of the responders 92.1% reported current foot problems: articular 73.8%, cutaneous lesions 65.4%, structural 57.6%, extra-articular 42.6%. Responders' median (IQR) disease duration 10 (5-20) years, HAQ 1.5 (0.75-2.0), FIS 10 (6-14) and FIS 16 (7-23) and 37.8% reported impacts on work. While 69.5% had accessed foot care there were differences in the route of access (by gender and whether independent or NHS provision) and were older (64.9 yr. vs 60.4 yr. = 0.001), had longer disease duration (12 yr. vs 7 yr. < 0.001) and had a greater proportion of females (72.2% vs 61.7% = 0.04) than those who had not accessed care.
Current foot problems were reported by 92.1% of the study sample and substantially impacted on life and work. While overall access to foot care was higher than anticipated, routes of access differed and extent of current problems suggests the provision of effective, timely and targeted care is a pressing need.
类风湿关节炎（RA）患者的足部症状源于炎症、足部力学改变、畸形和继发性皮肤病变的综合作用。指南建议定期检查患者的足部，但类风湿关节炎患者总体报告足部症状及获得足部护理的程度尚未明确。本研究的目的是确定某一地理区域内所有类风湿关节炎患者足部问题的患病率、影响及护理情况，并识别与获得足部护理相关的因素。
对居住在单一社区国民健康服务（NHS）足病服务范围内的类风湿关节炎患者随机样本进行横断面调查。问卷收集了人口统计学数据（年龄、性别、当地贫困得分）、临床数据（疾病持续时间、关节炎药物、残疾情况（健康评估问卷（HAQ））、当前足部问题、获得的足部护理（足病治疗、矫形器和/或矫形外科）及接受的护理、影响程度测量（足部影响量表）和工作能力。
目标人群中1003名符合条件的患者，739名收到了调查问卷包。其中413名（56%）回复。回复者和未回复者在年龄（63.5岁对61.5岁）、性别（女性占74.1%对75.2%）和最高贫困类别（13.3%对15.9%）方面相似。回复者中92.1%报告有当前足部问题：关节问题占73.8%，皮肤病变占65.4%，结构问题占57.6%，关节外问题占42.6%。回复者的疾病持续时间中位数（四分位间距）为10（5 - 20）年，HAQ为1.5（0.75 - 2.0），FIS为10（6 - 14），FIS为16（7 - 23），37.8%报告对工作有影响。虽然69.5%的患者获得了足部护理，但在获得护理的途径（按性别以及是否为独立或NHS提供）方面存在差异，获得护理的患者年龄更大（64.9岁对60.4岁，P = 0.001），疾病持续时间更长（12年对7年，P < 0.001），女性比例更高（72.2%对61.7%，P = 0.04）。
研究样本中92.1%的患者报告有当前足部问题，对生活和工作有重大影响。虽然总体获得足部护理的比例高于预期，但获得护理的途径不同，当前问题的程度表明提供有效、及时和有针对性的护理迫在眉睫。
