The Prevalence of Foot Ulceration in Rheumatoid Arthritis The Prevalence of Foot Ulceration in Rheumatoid Arthritis Jill Firth 1, Claire Hale 1, Philip Helliwell 2 and Jackie Hill 1 1 Academic Unit of Musculoskeletal Nursing, University of Leeds, 2 Academic Unit of Musculoskeletal Disease, University of Leeds West Yorkshire, UK Table 1 Baseline characteristics of respondents VariableResult Sex F: M (%)641:240 (73%) Mean age (range)63 years (20-94) Mean disease duration (range) 15 years (1-65) Ethnicity (%)785 (89%) white british; 44 (5%) pakistani; 22 (3%) indian. 3 Methods A foot ulcer was defined as an open sore or wound below the ankle which takes over 2 weeks to heal All patients with RA under review by consultant rheumatologists in Bradford, West Yorkshire were sent a postal questionnaire to establish overall and point prevalence (n=1130) Respondents were classified as false positives where diagrammatic questionnaire data indicated leg rather than foot ulceration A validation phase to this study is in progress. 2 Aims To establish the prevalence of foot ulceration in patients with RA in a single secondary care setting To describe the clinical characteristics of affected patients. 1 Background Foot ulceration is thought to be a common problem in people with rheumatoid arthritis (RA) but little research has been undertaken in this area. 6 Conclusions 10% of RA patients in a single secondary care setting reported a history of foot ulceration. 3% reported open ulceration at the time of the study. This prevalence data is currently in the process of being validated. Patients with open or healed foot ulceration had longer disease duration, reported greater use of special footwear and a higher prevalence of past foot surgery. The recurrent nature of this problem indicates that further work is needed to establish risk factors for foot ulceration in RA and to target foot health provision more effectively. Table 2 Differences between the groups Open cases n = 26 Healed cases n = 60 No ulcer n = 763 Χ 2 test (p value) Mean age (SD) 59.2 (16.6)62.7 (13.4)62.7 (12.9)KW 1.28 (ns) Sex M:F (% female) 7 : 19 (73%)11 : 49 (83%)212 : 551 (72%)2.52 (ns) Mean disease duration (SD) 19 years (14.0) 18.9 years (13.2) 14.1 years (10.9) KW 12.9 (0.002) Podiatry within past 12 months (%) 14 / 26 (54%)36 / 58 (61%)350 / 743 (47%)6.6 (ns) Wearing special footwear (%) 12 / 26 (46%)34 / 60 (57%)265 / 755 (35%)12.06 (0.002) Wearing prescribed insoles (%) 12 / 25 (48%)23 / 60 (38%)250 / 753 (33%)2.9 (ns) Previous foot surgery (%) 7 / 26 (27%)25 / 60 (42%)127 / 760 (17%)23.9 (0.0001) 4 Results The response rate was 78% following one reminder. Baseline sample characteristics are shown in table 1. The prevalence data is displayed in Figure 1. Adjusting for false positives, the overall prevalence of foot ulceration was 10% and the point prevalence 3%. If diabetic patients are excluded from the analysis, the prevalence of ulceration in RA is unchanged. 49 patients (57%) reported ulceration occurring on the toes; 53 (62%) on the forefoot; 27 (31%) on the rearfoot. 45 patients (52%) reported multiple episodes of ulceration ranging from 2-30 (median 2.00; IQR 1-4). The differences between open cases, healed cases and ulcer free patients are shown in table 2. Acknowledgements Jill Firth is funded by a Smith & Nephew Foundation Doctoral Scholarship Figure 1 - Prevalence data Figure 2 – Common sites for ulceration