Page 201 - Hospital Authority Convention 2018

Service Enhancement Presentations
Service Enhancement Presentations

F5.1 Healthcare Advances, Research and Innovations 09:00 Room 421

Foot Involvement in Patients with Psoriatic Arthritis
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Cheung HY ,Lai TL ,Chu H ,Lai KM ,Cheng CN ,Pang K ,Lee F ,Mo SK 1
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Podiatry Department, Kowloon East Cluster, Hospital Authority, Medicine Department, Tsueng Kwan O Hospital, Hong Kong
Introduction HOSPITAL AUTHORITY CONVENTION 2018
Foot pathologies are often related to diseases elsewhere in the body. Due to the fact that the foot is most distal to the
heart and constantly bears our body weight, it is often the first place where diseases manifest themselves. In patients with
Psoriatic arthritis (PsA), foot involvement is not uncommon. PsA is one of the prevalent systemic inflammatory arthropathies
associated with skin psoriasis (PsO), dactylitis, enthesitis and other comorbidities including diabetes mellitus, obesity and
metabolic syndrome. PsO was estimated to affect 2-4% of the Western population, compared to a lesser extent of 0.3% in
Hong Kong. Approximately 30% of PsO patients will develop arthritis in later life. Although foot involvement is very common
among patients among PsA, it is often neglected by the patients and the physicians. Apart from the classical skin silvery
plaque in feet, PsA can affect the feet in various unique ways, including dystrophic nails, toe dactylitis and Achilles tendinitis.
Moreover, foot manifestation can be the first sign of PsA in which most physicians and the patients would not pay attention
to. Early recognition of these foot features may aid making a prompt diagnosis of PsA. To our best knowledge, this study was
the first in our locality and was one of a few worldwide studies of this type to describe the clinical features of foot pathologies
in PsA.
Objectives
To describe the clinical characteristics of foot pathologies among PsA patients in order to gain a better understanding of their
current status.

Methodology
From June to December 2017, subjects aged 18 or above who fulfilled the Classification Criteria for Psoriatic Arthritis
(CASPAR) were consecutively recruited at the rheumatology clinics of Tsueng Kwan O Hospital (TKOH). Patients with either
foot amputated were excluded from the study. Basic demographics including age, sex and body mass index (BMI) were
recorded. Foot assessment was conducted by both rheumatologists and podiatrists in TKOH. Presence of callosity, psoriatic
nail features and toe deformities including hallux abductovalgus (HAV), hammering, clawing, mallet or overlapping of toes
and dactylitis in any of the toes were recorded. Moreover, presence of current foot pain was questioned. The validated Foot
Posture Index (FPI) was adopted to assess foot type. Data obtained was analyzed by using the Statistical Package for the
Social Sciences (SPSS) 17.0 for Mac (Chicago, IL, US). Descriptive analyses on demographic data were performed. All clinical
and related parameters were expressed as percentages and mean +/- standard deviation (SD) unless specified.

Results
A total of 26 participants were recruited in the study. All participants were Chinese in ethnic. The mean age of the participants
was 49.4 +/- 13.3, in which 65.4% were males and 34.6% were females. The mean BMI was 25.0, with 23.1% being
overweight and 46.2% being obese. 57.7% of participants had pronated foot type (flatfeet) and 7.69% had supinated foot type
(high arch feet). 61.5% of them suffered from at least one type of toe deformities including HAV, hammered or clawed toes.
46.2% complained of current foot pain. Foot callosity was found in 30.8% of the patients, with a majority of 75% located over
the plantar metatarsal area (PMA) of the foot. Psoriatic nail features were identified in 42.3% of participants. Only 11.5% of
patients had toe dactylitis. The present study demonstrated that a vast majority of PsA patients (96.2%) were suffering from
at least one and varying degree of foot conditions. In view of the high prevalence of foot pathologies among PsA patients, a
multi-disciplinary approach with involvement of podiatrists would be beneficial in the management of their foot disorders. Tuesday, 8 May 2018

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