Evaluation of laboratory, clinical, magnetic resonance imaging findings and pain-functional status response to a home-based exercise program in female patients with rheumatoid arthritis diagnosis with low-moderal DAS28 level

Objective: Foot involvement is twice as common in patients with rheumatoid arthritis compared to the general population. In addition to the advantages of the DAS28 score, which is widely used in the evaluation of disease activity, it does not evaluate the foot and ankle joints. The aim of this study was to determine the effect of inflammation on foot-ankle function, balance, general functional and psychosocial status in patients with foot-ankle pain and low-to-moderate disease activity according to DAS28, and the effect of a 6-week home exercise program on pain and foot function. Method: In our study; Patients who applied to the outpatient clinics of the Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University, Hafsa Sultan Hospital, diagnosed as rheumatoid arthritis according to ACR/EULAR classification criteria, who complained of foot pain, evaluated as having low-moderate disease activity according to DAS28, and had MRI for differential diagnosis of foot and ankle pain were included. Patients were divided into 2 groups, 14 patients in the exercise group and 14 patients in the control group, using a randomization scheme based on the date of initial evaluation and patient order, accessed via the internet. Patients in the exercise group were asked to exercise at least 3 days a week for 6 weeks. The control group was not treated. Patients were evaluated with VAS, FFI, DAS28, FPI-6, HAQ-DI, BDI, and BBS at first admission and then at 8th weeks. Results: According to the foot-ankle MRI reports, 78.57% of the patients had foot-ankle involvement was observed. In the exercise group, the mean DAS28 ESH value decreased from 3.49 to 3.04, the VAS value decreased from 58.57 to 40.36, the FFI overall score decreased from 50.16 to 39.06, the FFI activity limitation subscore decreased from 49.88 to 36.19, and the FFI disability subscore decreased from 48.69 to 41.98. Depression was detected in 64.29% of the patients according to BDI-II. While depression was seen at a rate of 71.43% at the beginning with exercise, this rate decreased to 57.14% at the end of 6 weeks. Conclusion: It was observed that foot involvement was common in patients even with low to moderate disease activity, there was a correlation between disease activity and scales evaluating foot function, and the role of foot care, follow-up and foot exercises in treatment should be emphasized more. Keywords: rheumatoid arthritis, exercise, foot, ankle, FFI