Looking through the ‘window of opportunity’: is there a new paradigm of podiatry care on the horizon in earlyrheumatoid arthritis?

Abstract

Over the past decade there have been significant advances in the clinical understanding and care of rheumatoid arthritis (RA). Major paradigm changes include earlier disease detection and introduction of therapy, and 'tight control' of follow-up driven by regular measurement of disease activity parameters. The advent of tumour necrosis factor (TNF) inhibitors and other biologic therapies have further revolutionised care. Low disease state and remission with prevention of joint damage and irreversible disability are achievable therapeutic goals. Consequently new opportunities exist for all health professionals to contribute towards these advances. For podiatrists relevant issues range from greater awareness of current concepts including early referral guidelines through to the application of specialist skills to manage localised, residual disease activity and associated functional impairments. Here we describe a new paradigm of podiatry care in early RA. This is driven by current evidence that indicates that even in low disease activity states destruction of foot joints may be progressive and associated with accumulating disability. The paradigm parallels the medical model comprising early detection, targeted therapy, a new concept of tight control of foot arthritis, and disease monitoring.'Podiatrists are experts on foot disorders: both patients and rheumatologists can profit from the involvement of a podiatrist'- Korda and Balint, 2004 [1].

Custom foot orthoses for rheumatoid arthritis: A systematic review

“…This means the emphasis is on orthotic devices that are specifically made for the participants rather than orthotic devices that can be purchased over the counter. This emphasis is required because the effect of RA on the foot and ankle can be different for each individual person (11).…”

Foot‐related health care use in patients with rheumatoid arthritis in an outpatient secondary care center for rheumatology and rehabilitation in The Netherlands: A cohort study with a maximum of fifteen years of followup

“…Woodburn et al describe a window of opportunity in the early phases of RA, consisting of the early detection of foot problems, targeted therapy, tight control of foot arthritis, and disease monitoring (20). It might be assumed that early podiatry intervention prevents further pain, loss of foot function, and loss of physical functioning, although there is limited evidence to support this assumption (21).…”

“…The present study points out the possibility of an underuse of care, which is an important target for future research. Further development of preventive health care strategies and integrated foot care (e.g., standard referral of newly diagnosed RA patients to the podiatrist) are possible strategies for the prevention of the underuse of care (20).…”

Using ultrasound to image the foot in rheumatoid arthritis: current understanding, challenges and future scope

“…A key paradigm shift in the management of foot pathology related to RA is in the advocacy for early detection, targeted therapy and tight control of foot disease, mimicking the medical model for exploiting the 'therapeutic window of opportunity' [71].…”

“…There is potential for the routine use of US to be an integral tool towards facilitating tight control of RA foot disease and the evaluation of management [52,[71][72][73][74]. Emerging evidence suggests that the use of US provides clinicians with the diagnostic capabilities to detect, grade and monitor active RA foot disease to expedite timely interventions [39,41,47,55].…”