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Abstract
BackgroundFoot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management. Therefore, the aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands.MethodsThe recommendations were based on research evidence and consensus among experts, following published strategies for the development of practice recommendations. The expert group was composed 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 recommendation i) the level of evidence was determined, and ii) the level of agreement (among the expert group) was set by an anonymous voting procedure using a numeric rating scale. The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7.ResultsIn total, 41 recommendations were developed. Two recommendations concerned a framework for diagnosis and treatment. Thirty-nine recommendations on foot care were developed: seven on diagnosis (including check-ups of feet and shoes and diagnostic imaging), 27 on treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin), four on communication, and one on organisation of RA-related footcare. All recommendations were approved by the expert group. The percentage score of NRS-agreement ≥7 ranged from 80 to 100%.ConclusionsThese are the first published multidisciplinary recommendations specific to the management of foot problems in people with RA. Multidisciplinary recommendations can provide guidance in timely referrals and access to adequate footcare. More research is needed to strengthen the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a first step towards developing international multidisciplinary recommendations for the management of foot problems in RA.
Highlights
Foot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life
The expert group was composed of patients and experienced professionals of several professions involved in RA footcare in the Netherlands
Our findings clearly indicate that there are gaps in scientific literature on the management of foot problems in people with RA
Summary
Foot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. The aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands. Foot involvement in RA may result in an abnormal foot function, limitations in daily activities such as standing and walking, and a reduced quality of life [7, 8]. It seems important to start management of foot problems in an early disease stage to reduce pain and activity limitations, and to prevent deterioration of foot function [9]. In the Netherlands there is a role for rehabilitation physicians, specialized nurses, podiatrists, orthopaedic shoe-technicians, and pedicurists in the management of RA-related foot problems [10]. A multidisciplinary approach is necessary in order to offer treatment with adequate content and timing for the individual patient [9, 11, 12]
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