Foot Problems and Their Conservative Treatment in Rheumatoid Arthritis

Miller, C; Nash, D.

doi:10.1016/s1047-9651(18)30493-5

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…Radiographic studies [42][43][44][45] have repeatedly shown that in rheumatoid arthritis, periarticular erosions seem to occur earlier and possibly more frequently in the feet than in the hands. Considering the interaction between inflammatory synovitis and mechanical stress, 46 it is possible that participants in this study have more osteoporotic damage in their feet. This has led to further speculation 45 that periarticular erosions in the foot may be more common owing to the subluxation of joints commonly observed in the feet of individuals with rheumatoid arthritis.…”

Section: Discussionmentioning

confidence: 99%

Use of Quantitative Ultrasound Scans of the Calcaneus to Diagnose Osteoporosis in Patients with Rheumatoid Arthritis

Cryer¹,

Otter

Bowen

2007

Journal of the American Podiatric Medical Association

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Background: Patients with rheumatoid arthritis are recognized as being at risk for osteoporosis as a result of the disease process as well as the medication used to treat it. This study was conducted to consider the use of calcaneal scanning with quantitative ultrasound—contact ultrasound bone analysis (CUBA)—to diagnose osteoporosis in patients with rheumatoid arthritis. Methods: Forty-six patients (11 men and 35 women) with established rheumatoid arthritis underwent dual-energy x-ray absorptiometry (DEXA) of the nondominant wrist and CUBA of the nondominant heel. Sensitivity, specificity, and positive and negative predictive values were used to determine the correlation between osteoporosis as diagnosed by the CUBA heel scan compared with the DEXA wrist scan given that DEXA is widely seen as the gold standard for the diagnosis of osteoporosis. Results: The CUBA heel scan revealed a sensitivity of 90% and a specificity of 44% for a diagnosis of osteoporosis compared with DEXA. The positive predictive value of the CUBA scan was 31%, and the negative predictive value was 94%. Therefore, if normal bone density is found using CUBA, there is 94% certainty this is correct. However, if osteoporosis is diagnosed using CUBA, there is only 31% certainty this is correct. In such instances a secondary scan using a different method (eg, DEXA) would be required. Future work should consider the effect of minor alterations to the equipment or scanning protocol, because this may improve diagnosis. Conclusions: The CUBA unit could be used as a primary screening device. Given the cost and accessibility issues associated with DEXA, quantitative ultrasound may have a role in screening for osteoporosis in the primary-care setting to determine the most appropriate routes of referral for patients requiring further investigations. (J Am Podiatr Med Assoc 97(2): 108–114, 2007)

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Section: Discussionmentioning

confidence: 99%

Use of Quantitative Ultrasound Scans of the Calcaneus to Diagnose Osteoporosis in Patients with Rheumatoid Arthritis

Cryer¹,

Otter

Bowen

2007

Journal of the American Podiatric Medical Association

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“…Plantar callosities are often present together with dorsal digital hyperkeratotic lesions, which, with continued over-loading, may ulcerate. Deformities are thought to result from the interaction of active synovitis and mechanical stress (Miller and Nash, 1994). The presence of extra-articular features such as rheumatoid nodules or vasculitis -which may itself lead to ulceration of the foot or leg -are further complications.…”

Section: Podiatric Management Of Patients On Biologic Therapymentioning

confidence: 99%

Biologic agents used to treat rheumatoid arthritis and their relevance to podiatrists: a practice update

Otter

Young

Cryer

2004

Musculoskeletal Care

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“…Involvement of the joints of the feet in rheumatoid arthritis (RA) and presence of secondary deformity is a common consequence of the disease process (Coughlin 1984;Miller and Nash, 1994;Smyth and Janson, 1997;Shrader, 1999;Weinger-Ogilvie, 1999). Michelson et al (1994) investigated the prevalence of foot involvement in 100 outpatients with RA and reported that 90% of the sample had symptoms in their feet and ankles.…”

Section: Introductionmentioning

confidence: 99%