Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis

Abstract

BackgroundFoot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management. Therefore, the aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands.MethodsThe recommendations were based on research evidence and consensus among experts, following published strategies for the development of practice recommendations. The expert group was composed of 2 patients and 22 experienced professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, and researchers) in the Netherlands. For each developed recommendation i) the level of evidence was determined, and ii) the level of agreement (among the expert group) was set by an anonymous voting procedure using a numeric rating scale. The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7.ResultsIn total, 41 recommendations were developed. Two recommendations concerned a framework for diagnosis and treatment. Thirty-nine recommendations on foot care were developed: seven on diagnosis (including check-ups of feet and shoes and diagnostic imaging), 27 on treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin), four on communication, and one on organisation of RA-related footcare. All recommendations were approved by the expert group. The percentage score of NRS-agreement ≥7 ranged from 80 to 100%.ConclusionsThese are the first published multidisciplinary recommendations specific to the management of foot problems in people with RA. Multidisciplinary recommendations can provide guidance in timely referrals and access to adequate footcare. More research is needed to strengthen the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a first step towards developing international multidisciplinary recommendations for the management of foot problems in RA.Electronic supplementary materialThe online version of this article (10.1186/s13047-018-0276-z) contains supplementary material, which is available to authorized users.

Outcomes and potential mechanism of a protocol to optimize foot orthoses in patients with rheumatoid arthritis

“…Although the results of the present study showed no evidence of the supposed relationship between plantar pressure and clinical outcomes, an optimal plantar pressure distribution may contribute to delaying forefoot joint damage and deformities, and prevention of abnormal callosities and wounds on the plantar surface of the foot [7,35]. Besides the characteristics of the prescribed FOs, compliance and the interaction between FOs and shoes worn by the patient may play an important role in the clinical results of the treatment [35]. Analyses of compliance in the present study showed that only 37% of the included patients wore the FOs more than 8 h a day.…”

“…In cases with relatively low plantar pressure values in the painful foot region (for example due pain avoidance in case of inflammation) another FOs-treatment strategy seems necessary. Likely, the working-mechanism of FOs in patients with RA-related foot problems is based on [35]. Furthermore, a placebo effect is a mechanism that should be considered [29].…”

“…Therefore, strategies to improve compliance (targeting usability and acceptance) should be considered [36]. Furthermore, good communication between prescribing clinicians and the individual patients is of great importance [35].…”

Metatarsalgia as osteoarticular cause of foot dysfunction

“…Zmiany skórne -hiperkeratozy, modzele, odciski i rany -przyczyna bólu w obrębie przodostopia (dokumentacja własna). Choroby zapalne stawów najczęstsze artropatie: reumatoidalne zapalenie stawów, młodzieńcze idiopatyczne zapalenie stawów, łuszczycowe zapalenie stawów, reaktywne zapalenie stawów w przebiegu chorób zapalnych jelit, dna moczanowa, chondrokalcynoza, artropatie w przebiegu chorób endokrynologicznych (nadczynność przytarczyc) [31,32,33] Artropatie w przebiegu zakażeń ropne zapalenie stawów (najczęściej wywołane Staphylococcus aureus), zapalenia stawów w przebiegu chorób zakaźnych: gruźlicy, kiły, rzeżączki, boreliozy, gorączki reumatycznej [34,35] Artropatie tkanek miękkich, szczególnie przydatne w szybkiej diagnostyce zapaleń stawów i ścięgien), badania laboratoryjne (diagnostyka chorób zapalnych i zakaźnych), tomografię komputerową (pomocna w dużych deformacjach i obrazowaniu zmian nowotworowych) oraz scyntygrafię kośćca (wykrywanie ognisk zapalnych i nowotworowych) [43].…”

Operative Rheumatologie des Vorfußes – ein Trend zu gelenkerhaltenden Eingriffen?

“…Dieser Umstand erklärt aber nicht, warum es trotz der hohen Prävalenz von Fußproblemen bei RA weiterhin an validierten interdisziplinären Behandlungskonzepten mangelt [8]. Auch besteht im Zusammenhang mit der klinischen Untersuchung weiterhin die Tendenz, eine zeitaufwendige Fuß-und Knöcheluntersuchung un- Auch stabilisieren sich die anfänglich hohen Prävalenzraten für Schmerzen und Schwellungen insbesondere im Bereich der Vorfüße im Verlauf der Erkrankung, was die Aufmerksamkeit reduzieren könnte, obwohl der inflammatorisch getriggerte artikuläre Schaden voranschreitet [11].…”