Interventions for foot disease in rheumatoid arthritis: A systematic review

Abstract

Objective. To systematically review medical and surgical foot intervention studies in rheumatoid arthritis (RA), focusing on clinical efficacy, study quality, and risk of harm. Methods. We searched appropriate databases using a combination of the terms "rheumatoid arthritis" and "foot" against terms indicating treatment; we also hand-searched references. We selected articles in English (1968 -2003) comprising randomized controlled trials (RCTs), controlled clinical trials (CCTs), prospective observational studies, and large retrospective observational surgical studies (>50 cases). RCT quality was examined using Jadad scoring; other designs were assessed qualitatively. Results. Inclusion criteria were met by 33 of 894 identified studies, comprising 5 RCTs and 1 CCT (all nonsurgical), 15 prospective observational studies (8 nonsurgical, 7 surgical), and 12 large retrospective studies (all surgical). Functional, custom-designed and semirigid orthoses and extra-depth shoes were effective in single RCTs of variable quality; no comparative studies have been conducted. This finding was supported by a CCT and prospective observational studies. There was no evidence of harm. There were no controlled trials of surgery. Prospective observational studies suggest that forefoot arthroplasty and first metatarsophalangeal joint implants, but not plantar callous debridement, are effective. Comparative retrospective analyses suggest that some procedure variants may be better, and surgery may relieve pain better than orthoses. Infection was the main risk. Conclusion. RCT evidence shows that orthoses and special shoes are likely to be beneficial in patients with RA. The only evidence of benefit from surgery comes from observational studies, because no RCTs have been conducted. Further RCT evidence is needed, although well-designed observational studies may be helpful.

Custom foot orthoses for rheumatoid arthritis: A systematic review

“…Additionally, the lack of completed studies of custom orthoses led to evidence for some outcomes being classified as inconclusive. These results are similar to previous reviews in this area that showed that foot orthoses may be beneficial for some outcomes such as pain (8,9). However, unlike previous reviews, effect sizes were able to be calculated for 3 outcome measures and a level of evidence was assigned for all outcome measures.…”

“…Consequently, orthoses are commonly used as an adjunct therapy (7). However, the evidence for the effectiveness of orthoses is lacking, as previously shown in other reviews (8,9).…”

Analysis of foot structural damage in rheumatoid arthritis: clinical evaluation by validated measures and serological correlations

“…I dati emersi da questo lavoro confermano l'opportunità dell'impiego, oltre ad adeguata terapia farmacologica, di una attenta valutazione clinica del piede reumatoideo anche in una fase precoce di malattia, che possa consentire di adottare rapidamente eventuali supporti meccanici, quali ortesi plantari, come ausilio nella prevenzione delle alterazioni anatomiche che si possono instaurare (19). Nonostante l'efficacia di supporti meccanici sia stata dimostrata sia in lavori di revisione (20,21) che in uno studio longitudinale di 6 mesi che ha evidenziato una riduzione, già entro il primo mese dall'applicazione della ortesi, del dolore e della limitazione funzionale (22), al momento non vi sono specifiche linee guida per la prescrizione della tipologia di ortesi plantare per i soggetti affetti da AR. La prescrizione spesso si basa su modelli standardizzati che non considerano il tipo specifico di alterazione strutturale presentata dal singolo soggetto e non ci si orienta sull'utilizzo di calzature idonee ed individualizzate in base alla tipologia dell'alterazione del piede (23)(24)(25).…”

Mid-term results of joint-preserving procedures by a modified Mann method for big toe deformities in rheumatoid patients undergoing forefoot surgeries

“…A variety of operative procedures have been reported for forefoot deformities of non-rheumatoid arthritis (RA) patients but, to date, reports on resection arthroplasty and arthrodesis of the metatarsophalangeal (MTP) joint only appear in the results of long-term follow-up series for rheumatoid forefoot deformities [1,[3][4][5].…”