Affiliation:
1. School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK
2. Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
3. Faculty of Health, School of Clinical Sciences, Podiatry, Queensland University of Technology, Australia
4. Department of Rehabilitation, Podiatry, National University Hospital, Singapore
Abstract
Abstract
Background
Psoriatic Arthritis (PsA)-related foot involvement has been shown to have a profound impact on daily functioning, with most studies having focused on predominantly Caucasian populations. The aim was to describe disabling foot pain (DFP) and its impact on daily living in PsA in Singapore.
Methods
A cross-sectional, retrospective study was conducted using clinical data collected during a single-visit to a rheumatology clinic in Singapore. Records for adults with physician-diagnosed PsA were reviewed for sociodemographic information, disease characteristics, global disease activityand burden. Foot-specific measures included clinical assessment and the Manchester Foot Pain and Disability Index used to define DFP and evaluate between-group differences.
Results
Forty-two participants with PsA (83% female, 57% Chinese, 31% Malay, 9.5% Indian, mean (SD) age 54-years (16)) attended the rheumatology clinic over the study-period. The median (IQR) disease duration was 2-years (11) and all were taking current DMARDs. Global disease measures demonstrated mild-to-moderate global disease activity and mild functional impairment, and were significantly higher in those with DFP.
Despite 90% reporting to be coping well with their condition, self-care and having emotional support (n=38), this study sample demonstrated high levels of anxiety/depression (29%), sleep disturbance (34%) and fatigue (24%), and a lack of disease- and drug-specific knowledge (64%). Further management was indicated for medication adherence counselling (48%), occupational therapy (43%), physiotherapy (36%) and podiatry (30%).
Nearly half had current foot pain with 40% reporting DFP (n=17), which caused significantly greater difficulty walking 3km and with 1-2 household tasks than those without DFP (p<0.05). Rearfoot enthesitis (plantar fasciitis, Achilles enthesitis) was the most common cause of DFP (67%) with pain lasting longer than 1-year. 72% were overweight or obese, with a high proportion not engaging in any cardiovascular exercise (70%). Three of 42 participants had previously seen a podiatrist.
Conclusions
People with DFP in PsA experience more severe global disease activity, reduced mobility and higher levels of negative impact on their daily lives in Singapore. In the absence of working in a multidisciplinary-team, there is value in comprehensive assessments that have potential to capture a holistic view of personal impact and improve person-centred care in PsA.
Publisher
Research Square Platform LLC
Reference61 articles.
1. Psoriatic arthritis: epidemiology, clinical features, course, and outcome;Gladman DD;Ann Rheum Dis,2005
2. Psoriatic arthritis: state of the art review;Coates LC;Clin Med,2017
3. Prevalence and incidence of psoriatic arthritis: a systematic review and meta-analysis;Scotti L;Sem Arthritis Rheumat,2018
4. Early psoriatic arthritis;McHugh NJ;Rheum Dis Clin N Am,2015
5. The epidemiology of psoriatic arthritis;Ogdie A;Rheum Dis Clin N Am,2015