A group of research analysing the feet of people with rheumatoid arthritis

Rheumatoid arthritis (RA) shows high prevalence and morbidity worldwide and its biggest impact can be observed in the small joints of the hands and feet. Pharmacological and other non-pharmacological interventions such as foot orthoses can play an important role in managing foot pathologies in patients whose systemic disease is controlled. However, the current situation is that there is a lack of qualitative and quantitative research to provide enough information about this topic. Furthermore, reliable and valid tools to assess the disease and interventions effect are vital to assess the effect that RA has on the feet. This thesis comprises six separate studies: first, four quantitative studies were performed to help to understand the potential role of RA and RA treatments on patients’ feet. Next, a protocol was developed to compare physical activity, general and foot health and foot health experiences in patients with RA when wearing three different types of foot orthoses. Finally, a qualitative study aimed at understanding the RA patients' experiences before and after wearing foot orthoses for 6 months. The findings of the quantitative and qualitative studies focused on foot orthoses suggest that the use of foot orthoses alleviate foot pain, reduce disability and improve physical activity. The systematic review which evaluates biologics on RA patients’ feet shows that postoperative surgical site infection or delayed wound healing were not associated with biologics use. Furthermore, the Self-Reported Foot and Ankle Score questionnaire presents acceptable methodological quality to assess the foot and ankle in patients with RA. Taken together, the results of this work show that foot orthoses are effective in the management of foot pain in patients with RA, reducing disability and improving physical activity. Some valid questionnaires are available to assess the disease and interventions effect in terms of foot and ankle, especially in clinical practice

Relationship between Kinesiophobia, Foot Pain and Foot Function, and Disease Activity in Patients with Rheumatoid Arthritis

Physical activity should be promoted in all people with RA, even in challenging times, such as a pandemic, to improve disease outcomes, well-being, and mental health, despite functional disability. The level of pain is related to the level of kinesiophobia in patients with RA.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Systematic review of the psychometric properties of patient-reported outcome measures for foot and ankle in rheumatoid arthritis

Background Foot problems and pain are common in patients with rheumatoid arthritis. Patient-reported outcome measures provide a standardized method of capturing patients’ perspectives of their functional status and wellbeing. There are many instruments specific to people with feet affected by rheumatoid arthritis but knowledge of their psychometric validation or methodological quality is lacking Objectives To identify patient-reported outcome measures specific to the foot and ankle and rheumatoid arthritis and investigate their methodological quality and psychometric properties Design Systematic review. Data source : A search was conducted for psychometric or validation studies on patient-reported outcomes in Rheumatoid Arthritis published in different languages, by examining the Pubmed; Scopus, CINAHL; PEDro and Google Scholar databases. Review methods . The systematic review performed was based on the following inclusion criteria: psychometric or clinimetric validation studies on patient-reported outcomes specific to the foot and ankle that included patients with Rheumatoid arthritis. Two authors independently assessed the quality of the studies and extracted datas Results Of the initial 431 studies, fourteen instruments met the inclusion criteria. Significant methodological flaws were detected in most with only SEFAS met the COSMIN quality criteria. Conclusion SEFAS had the best quality and was ranked most appropriate for use with patients living with Rheumatoid Arthriti

A Qualitative Study Exploring the Experiences and Perceptions of Patients with Hemophilia Regarding Their Health-Related Well-Being, in Salamanca

Hemophilia is a chronic, congenital/hereditary and X-linked disease, characterized by an insufficiency of factors VIII or IX, which are necessary for blood clotting. Those affected by hemophilia often suffer from particular psychosocial problems, both in the acceptance, coping, treatment and selfmanagement of their disease and in their family and social relationships, which are often mediated by these circumstances. The aim of this study was to explore the experiences of people with hemophilia or their family members, of in a specific region of Spain, regarding the impact of having hemophilia. Structured interviews were conducted and developed, using the studies of the World Federation of Hemophilia and Osorio-Guzmán et al. as a guide, as well as a literature review of qualitative work on hemophilia. Data were analyzed using a six-step thematic analysis. A total of 34 interviews were thematically analyzed. The results showed that three key themes emerged from the data: (1) the daily impact of having hemophilia, (2) uncertainty about the disease, (3) the role of associations and (4) support from institutions. The results make it clear that the disease has a major impact on their lives (work, family, leisure and personal environment). The main conclusion is that hemophilia has a negative impact on the daily lives of patients, families and caregiversMinistry of Science, Innovation and Universities (‘El sistema de salud español ante las enfermedades raras (1950–2019): profesionales y pacientes, investigación y asistencia’ PID2021-126019NB-I00) Proyectos de Generación de Conocimiento 2021Colegio Oficial de Enfermería de Granada (CODEGRA) for their help in the research support progra

Balance performance analysis after the COVID-19 quarantine in children aged between 8 and 12 years old: Longitudinal study

Background: Corona Virus Disease 2019 (COVID-19) has caused great changes in daily activities, especially in children. In Spain, to avoid infections, a home quarantine was declared, which caused a drastic reduction in daily or weekly physical activity in children. Objective: to analyse the balance performance after the COVID-19-induced quarantine on children's balance, through the use of balance tests, considering the type of sport practiced. Methods: an observational and longitudinal study was carried out with a sample size of 150 healthy children (69 boys and 81 girls) with a mean age of 10.02 ± 1.15 years. Postural control was evaluated under different equilibrium conditions before and after the quarantine period. Two data collections using the Gyko system were compared, with a difference of 8 months between them. In addition, the influence of foot type and physical activity was analysed. Results: After the quarantine, statistically significant differences were found in terms of balance results, which were worse than before (p 0.05).Physically active children (i.e., individual and / or collective sport) presented worse results than physically inactive children. A statistically significant impairment in terms of balance was demonstrated in children who performed high and moderate physical activity (p < 0.05). Conclusions: After the quarantine period, a significant reduction in balance performance was found in children. The findings suggest that regular physical activity benefits postural control. Loss of balance does not differ in postural stability by the type of sport practised. Postural stability is not influenced by the type of footprint after the period of physical inactivity. Postural control is influenced in children with a great level of physical activity

Biomarkers of aging associated with past treatments in breast cancer survivors.

Radiation and chemotherapy are effective treatments for cancer, but are also toxic to healthy cells. Little is known about whether prior exposure to these treatments is related to markers of cellular aging years later in breast cancer survivors. We examined whether past exposure to chemotherapy and/or radiation treatment was associated with DNA damage, telomerase activity, and telomere length 3-6 years after completion of primary treatments in breast cancer survivors (stage 0-IIIA breast cancer at diagnosis). We also examined the relationship of these cellular aging markers with plasma levels of Interleukin (IL)-6, soluble TNF-receptor-II (sTNF-RII), and C-reactive protein (CRP). Ninety-four women (36.4-69.5 years; 80% white) were evaluated. Analyses adjusting for age, race, BMI, and years from last treatment found that women who had prior exposure to chemotherapy and/or radiation compared to women who had previously received surgery alone were more likely to have higher levels of DNA damage (P = .02) and lower telomerase activity (P = .02), but did not have differences in telomere length. More DNA damage and lower telomerase were each associated with higher levels of sTNF-RII (P's &lt; .05). We found that exposure to chemotherapy and/or radiation 3-6 years prior was associated with markers of cellular aging, including higher DNA damage and lower telomerase activity, in post-treatment breast cancer survivors. Furthermore, these measures were associated with elevated inflammatory activation, as indexed by sTNF-RII. Given that these differences were observed many years after the treatment, the findings suggest a long lasting effect of chemotherapy and/or radiation exposure

Risk factors and associated factors for calcaneal apophysitis (Sever’s disease) a systematic review

Objectives The aim of this review was to identify the potential intrinsic and extrinsic risk factors (RFs), associated factors (AFs) and consequences of developing calcaneal apophysitis (CA). Design Systematic review. Data sources Cochrane Library, Embase, Medline Ovid, PubMed, Web of Science and Evidence, searched from inception to April 2021. Eligibility criteria We included cohort, case–control and cross-sectional studies that were conducted in patients younger than 18 years who were exposed to RFs or who presented with factors associated with developing CA. Studies in languages other than English or Spanish were excluded. Data extraction and synthesis Two reviewers worked independently to evaluate the risk of bias of included studies. The Newcastle–Ottawa Scale (adapted version) was used. Results A total of 736 studies were identified and 11 observational studies fully met the inclusion criteria, including 1265 participants with a mean age of 10.72 years. Four studies identified extrinsic factors, 10 identified intrinsic factors and three identified both. The extrinsic and intrinsic RFs, AFs and consequences of CA include limitation of ankle dorsiflexion, foot alignment, stiffness and mobility of the midfoot, plantar pressures and ground reaction force, body mass index, age, gender, presence of other osteochondroses and practice of sport. The risk of bias varied, being either moderate or low. Conclusions Regarding the factors and consequences associated with CA (Sever’s disease), ankle dorsiflexion limitation is the most frequent intrinsic factor studied, followed by peak plantar pressures and foot malalignment. However, disagreements between the investigators of the included studies were found; in some cases, there is a lack of unanimity between different studies as to which factors are considered to be RFs, AFs and consequences. PROSPERO registration number CRD42021246366

A Systematic review to identify the effects of biologics in the feet of patients with rheumatoid arthritis

Background and objective: Ninety percent of patients with rheumatoid arthritis (RA) feel foot pain during the disease process. Pharmacological treatment of RA has a systematic effect on the body and includes: Nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARDs) and biologics. The objective of our review was to examine the impact of biologics on patients with RA 'foot. Methods and material: A systematic review of randomized control trials and observational studies that evaluated the efficacy of biologics against other pharmacological treatment, and included a foot outcome measure. The search covered MEDLINE Ovid, Pubmed, CINAHL, Cochrane Library, Evidence Search, and Web of Science. Risk of bias was evaluated using Cochrane guidance and the Newcastle Ottawa Scale adapted version. Results: A total of eight studies fully met the inclusion criteria: Three randomized control trials, and five observational studies were the basis of our review. A total sample of 1856 RA patients with RA treatment participated. The use of biologics was not associated as a risk factor for post-operative surgical site infection or delayed wound healing. The benefits of biologics, in terms of the disease evolution, were assessed using Xray. Conclusion: Evidence suggests that the use of biologics is not a risk factor for post-operative surgical site infection or delayed wound healing. The use of biologics presents benefits in terms of the disease evolution assessed through X-ray

Relationship between Kinesiophobia, Foot Pain and Foot Function, and Disease Activity in Patients with Rheumatoid Arthritis: A Cross-Sectional Study

The main objective of the present study was to determine the relationship between kinesiophobia and pain (general and foot pain), foot function, and disease activity in patients with rheumatoid arthritis (RA). A total of 124 interviews were carried out with participants with RA. Participants were recruited from the Hospital Universitario Virgen de las Nieves de Granada in Spain. Interviews took place in January 2021. Participants completed the following questionnaires during an appointment with their rheumatologist: Foot Function Index (FFI), Tampa Scale for Kinesiophobia (TSK-11), and the Visual Analogue Scale Pain foot (VAS Pain). Furthermore, the Simplified Disease Activity Index (SDAI) was used to measure disease activity. Of the 124 participants, 73% were women, and their mean age was 59.44 years (SD 11.26 years). In the statistical analysis, positive linear correlations (p < 0.001) were obtained between the variables TSK-11 and VAS (related to general pain or foot pain) and FFI (in its three subscales). Additionally, a negative correlation between the TSK-11 and the educational background was shown. This study provided information about the relationship between foot function and pain with different levels of kinesiophobia in patients with RA. Additionally, the educational background of the patient was considered a predictor of whether or not a patient suffered from kinesiophobia.Partial funding for open access charge: Universidad de Málag

Follow-up of health-related quality of life and pain in a cohort of patients with rheumatoid arthritis before and after COVID-19

The foot is one of the anatomical structures of the body most affected in rheumatoid arthritis (RA), associated with the disability of patients, even more during COVID-19. The aim of this study was to analyse whether the period of physical inactivity during COVID-19 is an influential factor on health-related quality of life and foot pain in patients with RA. Methods: 162 patients with foot pain and RA, recruited from the Hospital Virgen de las Nieves, Granada (Spain) were included. Data was collected during two different periods: January - December 2018 in person and June - September 2021 by phone. Patients were asked to complete the Spanish adapted version of the 12-Item Short Form Survey (SF-12) and the Visual Analogue Scale (VAS). Results: The results from the SF-12 questionnaires were divided between its two subscales (i.e., mental, and physical component). The physical component shows an improvement between 2018 and 2021, from 32.05in 2018–35.18 in 2021 (p < 0.05). The opposite happened with the mental component, showing a dete- rioration, from 39.69 in 2018–34.48 in 2021 (p < 0.05). Regarding pain, VAS shows higher levels of pain with statistically significant differences, both in general pain (from 6 in 2018–7 in 2012) and in foot pain (from 5 to 7), (p < 0.05). Conclusion: Mental quality of life and pain, both general and foot pain, are influenced by the period of physical inactivity during COVID-19.Funding for open access charge: Universidad de Málaga / CBU