ArticleClinical rheumatology2026
Foot and ankle pain is associated with subsequent daily activity limitation independent of DAS28-CRP in rheumatoid arthritis: a longitudinal cohort study.
Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Foot and ankle pain in rheumatoid arthritis: the symptom is the signal, the underlying pathology the treatment target.Clinical rheumatology · 2026Article
- Persistent foot and ankle pain in rheumatoid arthritis remission: what is the treatment target?Clinical rheumatology · 2026Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
INTRODUCTION/
objectivesDespite treat-to-target strategies, clinically meaningful limitations in daily life often persist in rheumatoid arthritis (RA). As the Disease Activity Score in 28 joints (DAS28) excludes the foot and ankle, lower extremity symptoms may contribute to this residual burden. We aimed to determine whether foot and ankle pain was independently associated with daily activity limitation (DAL), beyond DAS28-CRP, and to explore the potential mediating role of foot-related quality of life.
methodsIn this single-centre longitudinal cohort study, adults fulfilling the 2010 ACR/EULAR classification criteria for RA were followed for up to four annual visits. DAL was assessed using a standardised single-item questionnaire. Foot and ankle pain was evaluated by interview and examination. Modified Poisson regression with generalised estimating equations estimated adjusted risk ratios controlling for age, sex, body mass index, visit number, and time-varying DAS28-CRP. Lagged and mediation analyses (SAFE-Q) were performed.
resultsAmong 171 patients (489 observations), the median follow-up duration was 2 years (interquartile range [IQR], 1-3), with a median of 3 visits per patient (IQR, 2-4). Foot and/or ankle pain was independently associated with DAL (risk ratio [RR] 1.86, 95% confidence interval [CI] 1.48-2.35). This association persisted across the DAS28-CRP spectrum, including remission. In lagged analyses, foot and/or ankle pain was associated with DAL at the subsequent visit (RR 1.56, CI 1.20-2.04). Foot-related quality of life was partially mediated by this association (37.2%).
conclusionsFoot and ankle pain was independently associated with DAL in RA, even in low disease activity or remission. These findings highlight the importance of systematic foot and ankle assessment beyond conventional disease activity measures. Key Points • Foot and ankle pain is independently associated with participation-level daily activity limitation in rheumatoid arthritis, beyond DAS28-CRP-defined disease activity. • This association persists even in patients within the DAS28-CRP remission range. • Foot-related quality of life may partially account for the association between foot/ankle pain and daily activity limitation.
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