Oral Presentation ARA-NSW 2017 - 39th Annual NSW Branch Meeting

The disease burden of foot problems in psoriatic arthritis (#6)

Deborah Turner 1
  1. Podiatric Medicine, Western Sydney University, Sydney, NSW, Australia

Research has shown that foot involvement in patients with psoriatic arthritis (PsA) is very high and can be associated with high levels of impairment of lower limb function and disability1,2. The clinical assessment of the painful foot in this group of patients can be problematic, as it is difficult to distinguish between synovitis, tenosynovitis, enthesopathy or pain related to mechanical dysfunction. Ultrasound data suggests that despite intensive and tightly controlled pharmacological management, enthesitis in the foot is detectable in a high proportion of patients3. The reasons for the predilection of the entheses in the foot in PsA are largely unknown but it has been shown that a high proportion of these patients have poor alignment of the rearfoot1, control of foot pronation and this has been suggested to make the tendons around the ankle more vulnerable to injury 4,5. Despite the high frequency of foot problems, to date very little is known about the foot function in PsA or the effectiveness of mechanical interventions such as foot orthoses.

This presentation will provide a brief overview of what is known currently on the nature and impact of foot problems in PsA, highlight the use of ultrasound in assessing disease activity in the foot in this group of patients and outline general principles for management.

 

  1. 1)E. Hyslop, D.E. Turner, I.B. McInnes, J. Woodburn. An outpatient survey of foot problems in psoriatic arthritis. Ann Rheum Dis 2008; 67 Suppl II: 527.
  2. 2)Queiro-Silva R, Torre-Alenso JC, Torre-Alenso JC, Lopez-Lagunas I. A polyarticluar onset predicts erosive and deforming disease in psoriatic arthritis. Annals of the Rheumatic Diseases 2003; 62: 68-70.
  3. 3)Borman P, Koparal S, Babaoglu S, Bodur H. Ultrasound detection of entheseal insertions in the foot of patients with spondyloarthropathy. Clinical Rheumatology 2006; 25: 373-377.
  4. 4)McGonagle D, Marzo-Ortega H, O'Connor P, Gibbon W, Pease C, Reece R et al. The role of biomechanical factors and HLA-B27 in magnetic resonance imaging-determined bone changes in plantar fascia enthesopathy. Arthritis and Rheumatism 2002;46(2):489-93.
  5. 5)Woodburn J, Hyslop E, Barn R, McInnes IB, Turner DE. Achilles tendon biomechanics in psoriatic arthritis patients with ultrasound proven enthesitis. Scand J Rheumatol. 2013;42(4):299-302.