Clinical and Structural Associations of Disability and Gait Performance in Patients With Rheumatoid Arthritis in Remission and Metatarsal Pain

J Foot Ankle Res. 2026 Mar;19(1):e70133. doi: 10.1002/jfa2.70133.

ABSTRACT

BACKGROUND: Patients with rheumatoid arthritis (RA) may continue to experience foot-related disability despite clinical remission. Foot involvement is associated with self-reported disability and objective gait alterations. Foot involvement is heterogeneous; studying patients with localised forefoot pain may help clarify which structural and inflammatory factors are associated with functional impairment.

OBJECTIVES: To identify clinical, structural and imaging factors associated with disability and gait performance in patients with RA in clinical remission with metatarsal-region forefoot pain.

METHODS: Cross-sectional study of 81 patients with RA in remission with metatarsal-region forefoot pain. Outcomes were Foot Function Index disability and activity limitation (FFI-D and FFI-AL), gait velocity (GV) and double-support time (DS). Associations were examined using Spearman correlations, age- and BMI-adjusted individual linear regression, parsimonious multivariable linear regression and exploratory cluster analysis.

RESULTS: Mean (SD) FFI-D and FFI-AL were 29.8 (29.4) and 29.1 (27.7); gait velocity (GV) was 0.90 (0.34) m/s and double-support time (DS) was 22.9 (8.2)% of the gait cycle. In bivariate and age/BMI-adjusted analyses, graded structural measures showed more consistent associations with disability and gait outcomes than dichotomous/count variables. In parsimonious models, disability (FFI-D/FFI-AL) was independently associated with pain intensity (VAS) and first metatarsophalangeal joint stiffness/limited dorsiflexion (1stMTP), whereas gait performance was mainly associated with age/BMI, greater graded forefoot structural severity and 1stMTP. Cluster analysis identified a higher grey-scale synovitis (GS)/lower structural-burden group and a lower GS/higher structural-burden group, with worse function and slower gait in the latter.

CONCLUSIONS: In RA remission with metatarsal-region forefoot pain, perceived disability is mainly associated with pain and forefoot stiffness, whereas gait performance is more closely related to age/BMI and graded forefoot structural severity. These findings support severity-based region-specific structural assessment alongside pain evaluation in clinical follow-up, to avoid underestimating the independent contribution of structural damage to function and gait.

PMID:41681131 | DOI:10.1002/jfa2.70133