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Heel pain frequently associated with spondyloarthritis

Heel pain associated with spondyloarthritis was frequently present, an early indicator of the disease, and was often recurrent and resistant to nonsteroidal anti-inflammatory drugs, according to recent study results.

Researchers conducted a cross-sectional, single-center observational study of 275 patients in Paris presenting with spondyloarthritis (SpA). They sought to determine the prevalence of heel pain, how its symptoms progressed, how to gauge its intensity and treatment modalities, and to identify the clinical symptoms associated with heel pain. The patients, 61.5% men, were recruited from November 2009 to July 2010 if they met Amor’s criteria for spondyloarthritis. The mean age of the study patients was 44.6 years.

Heel pain was reported by 47.1% of patients, and it was first experienced before or at SpA diagnosis in 54.6% of the cohort, with pain manifesting itself as the first symptom in 15.7% of patients. Heel pain was frequent in both axial (44.3%) and peripheral disease (48.2%), and the pain was more frequently observed at the inferior rather than the posterior portion of the heel (69.3% vs. 48%, P<.0001).

Recurrence was reported in 74.2% of the patients, and heel pain was considered intense by 70.3% and a source of limping in 71.6% of the cohort. In half the patients, the pain was resistant to oral nonsteroidal anti-inflammatory drugs (NSAIDs), while tumor necrosis factor blockers were effective in 76.6% of cases.

“This study confirmed heel pain as a frequent symptom in both axial and peripheral SpA,” the investigators said. “It occurred early in the disease course, and it was frequently recurrent and resistant to NSAIDs. Recent advances in terms of imaging and treatment by biologics should allow … a better understanding and treatment of this potentially disabling feature of SpA.”