The presence of forefoot problems and the role of surgery in patients with rheumatoid arthritis

Matricali, Giovanni; Boonen, A.; Verduyckt, J; Taelman, Veerle; Verschueren, Patrick; Sileghem, A.; Corluy, L; Westhovens, René

doi:10.1136/ard.2005.050823

Cited by 48 publications

(33 citation statements)

References 10 publications

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“…This highlights a specific need for specialist foot care in this group, especially in the face of a varied pattern of provision of foot care services around the UK [17]. In particular, RA patients are at high risk of foot ulceration (reported prevalence between 4 and 8%) [10,18]; consequently, it is clearly vital that early signs of decreased tissue viability are detected and managed aggressively, especially in immunocompromised patients [19].…”

Section: Discussionmentioning

confidence: 98%

“…A questionnaire was developed from items generated by focus groups with people with RA as well as podiatrists and rheumatologists. Items were then triangulated with validated tools previously used among those with RA [10,11], in systemic disorders where foot complaints are common [12] (e.g., diabetes) and measures for other chronic foot complaints [13]. We tested the questionnaire in two stages on people with RA attending a podiatry clinic and utilised their feedback in producing the final tool.…”

Section: Subjectsmentioning

confidence: 99%

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Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFα therapy: an epidemiological study

et al. 2010

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Epidemiological studies report foot pain affects more than 90% of people with rheumatoid arthritis (RA). Most data about foot involvement in RA were collected prior to the availability of novel treatments such as biologics. The objective of this study is to compare the prevalence of foot symptoms, frequency of foot examination, and access to foot care services among RA patients currently treated with anti-TNFα to those not receiving biologics. This study is a cross-sectional epidemiological study: a 28-item self-administered questionnaire was posted to 1,040 people with RA throughout the UK. Overall, 585 (55%) useable replies were received, and 120 (20.5%) respondents were currently taking anti-TNFα medication. Prevalence of current foot pain was 99% among the biologics group compared with 76% not treated with biologics. Stiffness, swelling, and numbness in the feet were all significantly more common in the anti-TNFα group (P < 0.05). Most respondents (90%) taking biologics discussed their foot pain with their rheumatologist, but only 70% were receiving podiatry (compared to 78% not taking anti-TNFα). Subjects reported that their feet were examined significantly less frequently (P < 0.001) than their hands. Foot complaints are common in this group, and allied health professions could enhance rheumatological care by undertaking foot assessment.

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Section: Discussionmentioning

confidence: 98%

Section: Subjectsmentioning

confidence: 99%

Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFα therapy: an epidemiological study

et al. 2010

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“…It is an undisputed fact that the foot, and in particular the forefoot, takes a major place in the surgical treatment of inflammatory joint diseases. Pain as a result of synovitis of the metatarsophalangeal (MTP) joints is often the initial symptom of rheumatoid arthritis and it is reported that within the first three years of rheumatoid arthritis, approximately 65 % of the patients have MTP joint involvement [2][3][4]. It is estimated that with chronic polyarthritis two thirds of patients will develop subluxation and dislocation of the lesser MTP joints.…”

Section: Introductionmentioning

confidence: 99%

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Louwerens¹,

Schrier

2013

International Orthopaedics (SICOT)

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Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.

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“…Until now, health care use in RA patients with foot symptoms has only been studied using a cross-sectional study design (5,12,13). Longitudinal data concerning the use of both conservative and surgical interventions are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Conservative management, consisting of foot orthoses in nonprescription shoes or therapeutic footwear, aims to decrease foot pain and disability (9 -11). Specific foot problems may require surgical treatment, such as severe subluxation of the MTP joints or severe hallux valgus (12).…”

Section: Introductionmentioning

confidence: 99%

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

Marsman

Dahmen

Roorda

et al. 2013

Arthritis Care & Research

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Objective. To describe foot-related health care use over time in a cohort of rheumatoid arthritis (RA) patients in an outpatient secondary care center for rheumatology and rehabilitation in The Netherlands. Methods. A total of 1,087 patients with recent-onset RA from 1995 to September 2010 were included in the study. All foot-related visits to the podiatrist, rehabilitation physician, orthopedic surgeon, and the multidisciplinary foot-care clinic were registered and described. Logistic regression techniques for longitudinal data were used to analyze the course of foot-related health care use. Results. A total of 32.9% of patients visited a podiatrist in secondary care during the course of their disease. For most patients, a visit to the podiatrist took place during the first year after diagnosis. This was followed by a significant decrease in visits in the ensuing years. Nine percent of patients visited the rehabilitation physician with foot symptoms, with peak prevalences between year 10 and 11 and during year 14 of followup. The orthopedic surgeon was visited by 5.3% of patients with foot symptoms, with a significant increase in visits over time. The multidisciplinary foot-care clinic was visited by 7.5% of patients. This was significantly associated with visits to the rehabilitation physician. Conclusion. In an outpatient secondary care center in The Netherlands, RA patients with foot symptoms visited the podiatrist in an early stage of the disease. When foot symptoms worsened, patients visited the rehabilitation physician, who subsequently referred patients to the multidisciplinary foot-care clinic for therapeutic footwear. The orthopedic surgeon was the final step in the management of foot symptoms.

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The presence of forefoot problems and the role of surgery in patients with rheumatoid arthritis

Cited by 48 publications

References 10 publications

Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFα therapy: an epidemiological study

Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFα therapy: an epidemiological study

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

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

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