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- Talk
- 22/09/2021
- UK
Clinical Assessment & Disease Pattern in the Rheumatoid Foot
Description
In this lecture delivered by Dr. Vivek Dhukaram, the focus is on clinical assessment and disease patterns associated with rheumatoid arthritis (RA), a systemic autoimmune disease that primarily affects the synovial joints. Dr. Dhukaram introduces the prevalence of RA, noting that it affects about 0.51% of the population in the Western world, with numbers increasing significantly in individuals over 50 years old. The lecture highlights the common occurrence of foot symptoms among patients, indicating that roughly 90% of them will experience foot issues, often presenting as the first symptoms of the disease.
Dr. Dhukaram elaborates on the pathogenesis of rheumatoid arthritis, discussing how inflammation leads to joint deterioration and the appearance of deformities in the foot, particularly in the smaller metatarsophalangeal (MTP) joints. These deformities can become fixed over time due to the scarring of tendons and muscles. The talk emphasizes that while surgeons cannot address the underlying inflammation, they can manage the resulting deformities and improve patient quality of life through corrective surgeries, such as joint-preserving osteotomies.
Subsequently, he examines the various stages of foot involvement in RA, noting that typical symptoms include dorsal rubbing, hammertoes, and pain under the metatarsal heads, which complicate the use of proper footwear. He describes diagnostic tests and features that differentiate RA foot deformities, stressing the need for careful assessment before surgical interventions due to potential healing complications associated with medications like steroids and biologics.
The lecture also touches on the impact of hindfoot deformities and the implications of associated factors, such as knee alignment and systemic health issues like smoking, which can adversely affect surgical outcomes. Dr. Dhukaram concludes with reflections on patient expectations and the satisfaction often reported by RA patients after surgical treatments designed to relieve their symptoms and improve their overall quality of life.