Background: Physical activity is increasingly promoted for patients with Rheumatoid arthritis (RA) and strongly recommended. However, adherence to regular physical activity remains low. Identifying the barriers to physical activity is a key element to understanding physical activity behavior in RA.

Objectives: Our objective was to assess the impact of foot involvement on physical activity among patients with RA.

Methods: We conducted a cross-sectional study including patients with RA, fulfilling the ACR-EULAR 2010 criteria. We collected the socio-demographic data and disease characteristics. Regarding the foot involvement, we assessed the presence of foot static disturbances and foot deformities through clinical examination, and radiographic damage. Physical activity was assessed by the Arabic version of validated International Physical Activity Questionnaire (IPAQ). According to this questionnaire, patients were subdivided into three groups: low, moderate and high physical activity.

Results: We included 94 RA (60 rheumatoid factor (RF) positive RA and 57 Anti Citrullinated Peptides Antibodies (ACPA) positive RA) patients. Eighty-six were females, mean age 52,12 ±9,743 years. The mean disease duration was 14,78 years ± 9,425. RA was erosive in 81 cases. Sixty-four patients had extra articular manifestations: pulmonary (n=15), dry syndrome (n=46), rheumatoid nodules (n=7) and osteoporosis (n=25). Mean DAS28CRP score was 3,67 ±1,58 and mean HAQ score was 0,88 ± 0,65. Eighty patients were treated by cs-DMARDS and 31 by biologics: infliximab (n=3), etanercept (n=3), adalimumab (n=2), golimumab (n=3), certolizumab (n=1), tocilizumab (n=11), rituximab (n=4).

Forty-six patients complained of fore foot pain, 34 of mid foot pain and 19 of hind foot pain. Mean visual analogue scale for foot pain was 3,6 ±3,05, and no significant correlation was shown with IPAQ score (p=0,19, r=0,138). Foot static disturbances were present in 66 patients: bilateral flat foot (n=31), hallux valgus (n=59), claw toes (n=33) calcaneal valgus (n=25), peroneal tenosynovitis (n=24), tibialis posterior tenosynovitis (n=18), ankle arthritis (n=15) and mid-foot arthritis (n=18). We didn’t find a significant association between lower IPAQ score and foot deformities (p=0,235), the presence of peroneal tenosynovitis (p=0,438) and tibialis posterior tenosynovitis (p=0,113).

As regards X-rays findings, bone erosions were found in 58 patients, joint narrowing in 65 patients, and dislocation of the MTP joints in 17 patients. No positive association with lower IPAQ score was found with structural damage: erosions (p=0,938); joint narrowing (p=0,258) and dislocation of the MTP joints (p=0,884). DAS28 was higher among patients with low physical activity (mean DAS28crp among this population was 4,16 compared to 3,63 among patients with high physical activity), but without reaching a significant threshold (p=0,432, r=-0,85).

Conclusion: Increasing physical activity in RA patients is an ongoing challenge. In this study, no association was found between foot involvement in RA and a lower IPAQ score.

Disclosure of Interests: None declared