Multidisciplinary Recommendations for managing Foot Problems in Rheumatoid Arthritis patients

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Multidisciplinary Recommendations for managing Foot Problems in Rheumatoid Arthritis patients

The first published research article on the multidisciplinary recommendations specific to the management of foot problems in people with rheumatoid arthritis (RA) was published in the 'Journal of Foot and Ankle Research'. These multidisciplinary recommendations can issue guidance in timely referrals and access to proper footcare. 

Foot problems are commonly observed in RA patients and have a significant impact on their quality of life. The healthcare professionals from various professions help to manage these foot problems. Presently, there is no agreement on the optimal management. Hence, this present study was performed with an objective to formulate multidisciplinary recommendations for the management of foot problems in RA patients in the Netherlands.

Firstly, the published plans for the development of practise recommendations were considered and then the recommendations were made based on research evidence and consensus among experts. The expert panel comprised 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 recommendations: a). Level of evidence was determined, and b). Level of agreement (by the expert group) was set by an anonymous voting method via a numeric rating scale (NRS). For each recommendation, the mean and range of the level of agreement were evaluated. A recommendation was approved only when ≥70% of the expert group voted for an NRS-agreement ≥7.

A total of 41 recommendations were formulated. Out of which, 2 recommendations emphasized on framework for diagnosis and treatment; and 39 on foot care. These 39 recommendations comprised of:

  • Diagnosis (including check-ups of feet and shoes and diagnostic imaging)- 7 recommendations,
  • Treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin)-27 recommendations,
  • Communication- 4 recommendations
  • Organisation of RA-related footcare- 1 recommendation

The expert group approved all the recommendations with a percentage score of NRS-agreement ≥7 ranging from 80 to 100%.

For future analysis, more research is required to confirm the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a crucial first step towards developing international multidisciplinary recommendations for the management of foot problems in RA patients.

Source

Journal of Foot and Ankle Research

Link to the source

https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0276-z

Original title of the article

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

Authors

Marloes Tenten-Diepenmaat et al.

SearchTags: 
Exploratory, Rheumatoid arthritis, Joints, Recommendations, NRS-agreement ≥7
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