الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis is a chronic progressive, inflammatory auto-immune disease that affects primarily the small joints of the hands and feet. Most commonly affected joints are that of the wrist and hands bilaterally and symmetrically, leading to chronic pain, bone erosions and deformities. It is often accompanied with extra-articular and systemic manifestations. Disease severity varies considerably among patients according to multiple complex genetic and environmental factors.
Foot and ankle involvement increases with duration of the disease process, and more than 90% of rheumatoid arthritis patients have foot and ankle symptoms at later stages. Foot deformities were reported to severely affect quality of life in rheumatoid arthritis patients. Few studies tried to illustrate the relation between either clinical, laboratory or radiological burden of the disease, that made it mandatory to study more these parameters.
The aim of this study was to monitor the patterns of foot joint damage in rheumatoid arthritis patients and its correlation with disease activity parameters, as well as its impact on functional ability.
The included rheumatoid arthritis patients were diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis. Among the studied patients, rheumatoid arthritis was common in females more than males.
Patients having existing or history of previous foot surgery, any congenital foot deformity or local or systemic arthritic or bone disorders that may affect foot bones or joints were excluded from the study.
Complete joint examination was performed, self-reported duration of rheumatoid arthritis was recorded. Disease activity was evaluated using visual analogue scale for pain and fatigue, C-reactive protein, the erythrocyte sedimentation rate, Disease activity score-28 was calculated. Functional assessment was done using modified health assessment questionnaire.
Full drug history was recorded. Radiological assessment was conducted using Plain X-ray standing antero-posterior ankle views, standing lateral foot radiographs, and oblique radiographs of the foot were taken and graded according to Larsen score.
Majority of studied feet were normal, the forefoot is the most common site of involvement.
Forefoot was graded according to severity to be at grade 1 in more than half of the studied patients, with grade 5 representing the least grade in forefoot affection. At mid-foot affection, all patients were grade 1. In combined foot affection, the majority were grade 1.
There was significant relation in the level of disease activity parameter represented by Erythrocyte Sedimentation Rate, and the use of anti-inflammatory drugs among the studied rheumatoid arthritis patient in the last 6 months (p=0.031). The mean of Erythrocyte Sedimentation Rate was higher in patients taking corticosteroids than in patients taking non-steroidal anti-inflammatory drugs and the lowest mean was in patients taking combination of corticosteroids and non-steroidal anti-inflammatory drugs. The previously mentioned finding was not apparent when using (C - reactive protein) as parameter of disease activity index (p=0.115).