Impact of Foot Surgery and Pharmacological Treatments on Functionality and Pain in Rheumatoid Arthritis: A Five-Year Longitudinal Study

Abstract

Background: Rheumatoid arthritis (RA) frequently leads to foot deformities, significantly impacting pain, mobility, and quality of life. Surgical and pharmacological treatments are prescribed to manage symptoms, but their long-term effects on foot function remain unclear. This study evaluates the impact of different treatment approaches, including surgery, methotrexate (MTX), and biological therapy (Bio), on foot functionality and pain progression over five years. Methods: A longitudinal cohort study was conducted with 103 RA patients classified into five groups: surgery, MTX < 10 years, MTX ≥ 10 years, Bio < 10 years, and Bio ≥ 10 years. Data from 2018 and 2023 were compared using the Visual Analog Scale (VAS), the Manchester Foot Pain and Disability Index (MFPDI), and the Foot Function Index (FFI). Statistical analyses included ANOVA, Kruskal–Wallis, and ROC curve analysis to assess differences between groups and identify key progression factors. Results: Patients with ≥10 years of disease duration and non-biological treatment (MTX ≥ 10 years) experienced the most severe deterioration in foot function, with a mean FFI increase of +11.89 points (p < 0.01). In contrast, MTX < 10 years was the only group to show an improvement in foot function (FFI: −5.29, p = 0.02). The surgery group exhibited moderate but highly variable functional changes, while patients on biological therapy showed less progression in pain and disability compared to their non-biologic counterparts. Hallux abductus valgus severity increased across all groups. Conclusions: Patients with long-standing RA on non-biologic therapy exhibited the greatest decline in foot function, whereas early treatment with MTX (<10 years of disease duration) appeared to slow deterioration. Surgery did not consistently provide functional benefits, and biologics helped mitigate progression, though outcomes varied. These findings underscore the importance of early intervention and personalized treatment strategies for foot preservation in RA.