Research article

Forefoot disease activity in rheumatoid arthritis patients in remission: results of a cohort study

Marike van der Leeden¹ , Martijn PM Steultjens^1,2 , Dirkjan van Schaardenburg^3,4 and Joost Dekker^1,2

¹  Department of Rehabilitation Medicine and Psychology, Jan van Breemen Institute, Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands

²  Department of Rehabilitation Medicine, VU University Medical Center EMGO Institute, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands

³  Department of Rheumatology, Jan van Breemen Institute, Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands

⁴  Department of Rheumatology, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands

author email corresponding author email

Arthritis Research & Therapy 2010, 12:R3doi:10.1186/ar2901

Published:	7 January 2010

Abstract

Introduction

The aim of our study was to investigate the presence of disease activity in the metatarsophalangeal (MTP) joints of the forefoot in rheumatoid arthritis (RA) patients in remission according to the Disease Activity Score based on 28 joints (DAS28) remission criterion.

Methods

A total of 848 patients with recent-onset RA were included from 1995 through 2007. The DAS28 and pain and swelling of the MTP joints were assessed annually. The data were analyzed using descriptive techniques.

Results

On average, 35% of the patients fulfilled the remission criterion of DAS28 <2.6 during the first eight years of RA. On average, 29% of these patients had at least one painful MTP joint and, on average, 31% had at least one swollen MTP joint during follow-up. Forty percent, on average, had at least one involved MTP joint (pain and/or swelling).

Conclusions

Painful and/or swollen MTP joints were detected in a substantial proportion of patients classified as being in remission. Therefore, examination of the foot joints - irrespective of the patient's state of remission - seems indicated in order to provide optimal foot care.