Presentation on theme: "Podiatry and the treatment of Rheumatoid Arthritis"— Presentation transcript:
1 Podiatry and the treatment of Rheumatoid Arthritis Sue McAuslandPodiatrist,Blackpool Teaching Hospitals NHS Trust
2 Standards /Guidelines NICE (2009) guidelines (CG79)Podiatry Rheumatic Care Association (PRCA)Arthritis and Musculoskeletal Alliance (ARMA) Standards of Care for people with musculoskeletal conditionsNorth West Clinical Effectiveness Guidelines for RA- objective to improve foot and ankle assessment an management
3 NICE GuidelinesRheumatoid Arthritis is an inflammatory disease that largely affects synovial joints which are lined with a specialised tissue called synovium.It typically affects the small joints of the hands and the feet, usually both sides (symmetrical), although any synovial joint can be affected.
4 Stats 400,000 in UK have RA. 12,000 a year in UK develop RA 2-4 times greater in woman than menPeak age is 70, but can develop at any agePeople who have synovitis of undetermined cause should have hands and feet x-rayedThe foot is affected in nearly all people with RA eventuallyIn the foot, joint pain and stiffness is the most common initial presentation, but other features eg tenosynovitis, nodule formation and tarsal tunnel syndrome may present, reflecting soft tissue involvement.
5 National Guidelines and Podiatry All People with RA and foot problems should have access to a podiatrist for assessment and periodic review of their foot health needs (NICE Recommendation 14)ARMA recommends people with RA should be seen by specialist within 12 weeks to confirm diagnosis and to give access to MDT access including foot health assessment- it does not have to be a podiatrist.Functional insoles and therapeutic footwear should be available for all people with RA if indicated (NICE Recommendation 15)
6 Basically Doing the right thing To the right patient In the right way At the right time
7 How can RA affect the feet? Hallux valgusValgus heel deformityLesser toe deformities causing hard skin (callus) formation. For some this leads to foot ulceration particularly in those with poor tissue viabilityBacterial and fungal infectionsNail pathologies that increase risk of ulceration and systemic infection
8 What are we attempting to do? Relieve painMaintain foot functionImprove quality of lifeUsing safe/cost effective treatments such as:Palliative foot carePrescribed orthosesSpecialist footwear
9 What do Podiatrists provide Aiding early recognition of undiagnosed MSK disease as foot may be first site of involvement before any other manifestation of the diseaseEducation – self management advice including footwear advice. Considered the minimum standard for people with RA. Footwear flyers. British Footwear Assoc for hard to find footwearGeneral foot care, nail cutting, corn and callus, padding , offloading pressure areas.Provision of orthosesMonitoring of risk factors due to RA such as ulcerations, skin conditionsTreatment of ulcersReferral for surgical opinion when joints become unmanageable
10 Callus on feet Should we remove it? Argument for and against. Callus removed – does it help pain relief. Needs to be often to be of benefitCallus removal may be necessary to expose an ulcer.Argument against suggest that pressure relief is more effective management in the long-term with use of orthoses.
11 Fungal infections At increased risk with immuno-suppressed Increased risk of ulcer underneath nail if left untreatedTreatment:Take nail clippings/ positive result treat with oral meds/nail lacquer
12 Ingrowing toenails Mild condition Conservative + antibiotics (where indicated)Severe conditionPartial or total nail removalBiologics – may complication treatment path /consult rheumatologist
13 Orthoses Early intervention for symptomatic pain Advanced problems To help reduce pain and prevent further deformityAdvanced problemsMay prevent tissue breakdown for poor tissueTypes of insoles:Simple cushioningInsoles with paddingContoured padding (custom or off-shelf)