05:05am Sunday 19 November 2017

‘Bring the feet in when diagnosing and treating Rheumatoid Arthritis’

When diagnosing and treating patients with rheumatoid arthritis (RA), clinical research focuses primarily on the joints in the upper body. However, research carried out by rheumatologist Hetty Baan at the University of Twente reveals the importance of including the feet and ankles when examining and treating RA patients. She also makes the case for further research into how the treatment of RA patients can be improved in practice in order to prevent unnecessary infections and damage in the feet and ankles. Baan will defend her doctoral research on 6 December at the Faculty of Behavioural Sciences of the University of Twente.

Rheumatoid Arthritis (RA) is a painful form of rheumatism which is characterized by infections in the joints and soft tissues. A method known as DAS-28 is often used to gauge the seriousness of the condition. DAS stands for Disease Activity Score. The method involves examining 28 joints in the upper body and checking the knees for pain and swelling. The results are weighted together with the results of laboratory tests and the patient’s pain score, which ultimately gives a figure that indicates how active the disease is.

In practice, the feet and ankles of RA patients receive only limited attention. However, problems with the feet and ankles can significantly impact on the patients’ mobility, and thus their social lives too. As a result of her research at the University of Twente, rheumatologist Hetty Baan makes the case for the use of a DAS 44, which would also include the feet and ankles. This could improve treatment and prevent unnecessary infections and damage.

Baan also sees the added value in the more frequent use of MRI scans for the purpose of diagnosis and treatment. This method can detect not only damage and infections in the joints, but also any abnormalities in the tendons. In Baan’s research, 70 percent of the patients were suffering from abnormal tendons. Baan says that more research is needed to look at how the diagnosis and treatment of foot and ankle problems can be improved further, however.

The research
Hetty Baan carried out her research among 30 outpatients being treated for RA. She investigated whether and in what order they were experiencing problems with their feet. The patients underwent clinical tests and completed questionnaires, a gait analysis was conducted and various forms of medical imaging were carried out (ultra-sound imaging, x-rays and MRI scans).

Hetty Baan is a rheumatologist affiliated to the ZGT hospital in Almelo. She completed her doctoral research in the department of Psychology, Health and Technology at the University of Twente. Her supervisors for this research were Professor Mart van de Laar and Professor Hermie Hermens. The research was carried out in collaboration with the Twente Rheumatology Centre (the department of Rheumatology and clinical immunology of the Twente Medical Spectrum) and was financially supported by the charity Reumafonds.

Note to the press
For more information on this subject or for a digital version of the thesis ‘Can we explain gait changes in rheumatoid arthritis’, please contact Science Information Officer Joost Bruysters (053 489 2773 / 06 1048 8228).


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