Multidisciplinary approach in the treatment of tendinous foot involvement in rheumatoid arthritis

Abstract

Introduction: Patients with rheumatoid arthritis frequently consult for pain resulting from involvement of the tendons of the foot. This pain negatively afects foot biomechanics and quality of life. The most widely used treatment option for this condition is ultrasound-guided steroid injection, while other treatments were recommended such as heel pad, splints, and footwear.

Objective: To evaluate a joint intervention (rheumatology and podiatry) comprising an orthotic-podiatric treatment and infltrations. We evaluated the response using ultrasound monitoring, a pain scale, functional tests, and assessment of patient satisfaction.

Methods: We performed a non-controlled blinded prospective interventional study of 96 patients with foot pain and selected those with ultrasound-confrmed tendon involvement. Patients enrolled started intervention treatment and were followed for 6 months. The outcome of the intervention was compared with the patient’s baseline status. The pre-post diferences in the secondary variables (pain, disability) were analyzed using the t test and contingency tables or the Mann–Whitney test.

Results: Using our protocol, we recorded a rapid and signifcant reduction in the intensity of pain, in the foot function index, and in the ultrasound parameters (grayscale and Doppler). Structural damage to the tendon improved more slowly, with signifcant outcomes only at the last visit with respect to baseline. Abnormal foot support was detected in 50% of patients, and 79.5% were using inappropriate footwear.

Conclusions: Our multidisciplinary therapeutic protocol enabled a very signifcant improvement in tendon involvement. It was well-tolerated, with a high degree of satisfaction, and was easily evaluated using ultrasound. No changes in background medication were necessary.