الفهرس 
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Abstract
Foot related complications in RA patients are poorly understood in comparison to problems of the hand or systemic disease. Structures which incorporate a synovial membrane such as joint linings, tendon sheaths or IM bursae, are among the most frequently affected by excessive disease mediated inflammation in patients with RA.
Forefoot bursae are of particular interest in patients with RA as they are potentially responsive to both disease mediated inflammation and adverse biomechanical function. Moreover FFB may affect foot function causing disability and activity limitation.
The aim of the current study is to investigate the prevalence and distribution of FFB in RA patients and their impact on the foot.
The study was conducted on 100 RA patients diagnosed according to the 2010 ACR/EULAR classification criteria and were recruited from the outpatient clinic of physical medicine, Rheumatology and Rehabilitation department in the Main University Hospital in Alexandria faculty of Medicine. RA patients with diabetes mellitus, sensory neuropathy, associated rheumatologic diseases, or with local foot disease were excluded.
Demographic and clinical data including disease duration, drug intake, VASF, disease activity using CDAI, laboratory tests including ESR, CRP and RF were collected from all studied patients.US of the forefeet under the standardized EULAR guidance was done for all patients. According to the forefoot US findings, the studied patients were classified into group I; those with US detectable FFB and group II: those without US detectable FFB. group I patients were further subjected to FIS, foot anatomical changes assessment and gait analysis.
Most of the studied patients were females (91 females and 9 males), aged from 23 to 67 years with disease duration ranged from 1 to 33 years. The mean BMI in the studied patients was 29.53 ± 5.01 kg/m2. At the time of examination 9 patients were in remission, 23 patients were in low disease activity and equal number for moderate disease activity, while the larger number of patients (45) was for those with high disease activity according to the CDAI values. The mean CRP level was 13.77 ± 16.83mg/dl and that of the ESR was 45.46 ± 25.69mm. 69 patients were RF positive among them 36 patients were having high positive. The VASF ranged from 0 to 82. Foot deformities were found in 79% of group I patients. The FIS which was done for group I patients ranged from 7 to 40 with a mean value of 19.13 ± 7.29. Ultrasound detected synovial hypertrophy of the MTP joints was present in 60% of the studied patient. Ultrasound detectable FFB was found in 92% of the patients with the most frequent IM bursa was the fourth one and the most frequent SM bursa was the first. There was statistical significant relation between FFB and FIS and its 2 subscales, MTP synovial hypertrophy, serum CRP level, VASF and step length. No statistical significant correlation was found between FFB and BMI, CDAI or the foot anatomical changes. Moreover no statistical significant correlation was found between FIS and CDAI.
In conclusion, US detectable FFB are highly prevalent in rheumatoid arthritis patients and appear to be a significant contributory factor to patient related foot disability. Foot disability can occur regardless the disease activity state.