We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis.

We studied rheumatoid arthritis (RA) patients with foot complaints to address the associations between clinical signs and symptoms, radiographic changes, and function in connection with disease duration. Secondly, we describe the contribution of several foot segments to the clinical presentation and function. In 30 RA patients with complaints of their feet, attributed to either signs of arthritis and/or radiographic damage, we compared radiographic, ultrasound, clinical, and functional parameters of the feet and ankle. Pain and swelling of the ankle were correlated weakly but statistically significantly with limitation and disability (0.273 to 0.293) as measured on the 5-Foot Function Index (FFI). The clinical signs of the forefoot joints did not influence any of the functional outcome measures. Radiographic scores for both forefeet (SvdH) and hindfeet (Larsen) were correlated with the total Health Assessment Questionnaire Disability Index (HAQ DI) and the 5-FFI limitation subscale. Pain and disease duration, more than radiographic damage, influence the total HAQ DI significantly. With the progression of time, structural damage and function of the rheumatic foot worsen in RA patients. Pain and swelling of the ankle contribute more to disability than radiographic damage of the foot and ankle.

Magnetic resonance imaging of the rheumatic foot according to the RAMRIS system is reliable.

OBJECTIVE: In rheumatology, magnetic resonance imaging (MRI) is predominantly applied in the assessment and outcome measurement of rheumatoid arthritis (RA) in hands and wrists, leading to the development of the RAMRIS (RA-MRI-Scoring) system. It was initiated by the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT). The RAMRIS system has not been applied widely in the measurement of feet. We investigated the interreader and intrareader agreement of the RAMRIS scoring system in the assessment of feet in RA. METHODS: Twenty-nine patients with RA who had radiological damage and/or arthritis underwent MRI. Two experienced readers independently read both complete sets. One reader read 6 random sets after the initial session, in order to assess the intrareader agreement. For evaluation of the intrareader and interreader reliability, quadratic-weighted κ scores were calculated per joint and lesion. RESULTS: For the forefeet, interreader scores were excellent, ranging from 0.77 (bone edema) to 0.95 (bone erosion). Hindfoot interreader agreement scores were highest for erosion (0.90) and synovitis global score (0.88), but edema and synovial thickness agreement were also acceptable (0.83 and 0.86). Intrareader scores were on the whole slightly lower, but excellent. CONCLUSION: Reliability (interreader and intrareader agreement) in the assessment of the rheumatoid foot according to the RAMRIS method is excellent.

Arm crank ergometer is reliable and valid for measuring aerobic capacity during submaximal exercise.

Measuring physical fitness becomes more important. Yet most instruments depend upon the function of the lower extremities. Hence, we investigated whether an adapted submaximal arm crank test on an ergometer for the upper body is reliable to use, and if the submaximal test for the arm crank ergometer is valid compared to the test on the bicycle ergometer. Different types of reliability measures of the adapted submaximal test on an arm crank ergometer were assessed in healthy volunteers, such as test-retest, interobserver, interergometer, and between arm crank and bicycle ergometer. A crossover design was used. The measurements were proportionally distributed over 30 volunteers. Based on the intraclass correlation coefficient (ICC) and the magnitude of within-person differences, we revealed a good reliability of the submaximal test. For the test-retest reliability, the ICC was 0.76, the interobserver reliability was 0.82, and the interergometer reliability 0.63. In addition, the criterion validity was also tested by comparing the calculated VO2max during the submaximal test on the arm crank ergometer and on the bicycle ergometer. Between VO2max on the arm crank and bicycle ergometer, an ICC of 0.64 was found. The results of the submaximal test on the arm crank ergometer are reliable and valid as compared with those on the bicycle crank ergometer. We showed that the submaximal test on the arm crank ergometer is suitable for measuring physical fitness in healthy people. We expect that disabled people can use this submaximal test on the arm crank ergometer for measuring their physical fitness, also.