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Open Access Highly Accessed Commentary

Looking through the 'window of opportunity': is there a new paradigm of podiatry care on the horizon in early rheumatoid arthritis?

James Woodburn1*, Kym Hennessy1, Martijn PM Steultjens1, Iain B McInnes2 and Deborah E Turner1

Author Affiliations

1 Musculoskeletal Rehabilitation Research Group, Institute of Applied Health Research, School of Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK

2 Glasgow Biomedical Research Centre, University of Glasgow, 120 University Place Glasgow, G12 8TA, UK

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Journal of Foot and Ankle Research 2010, 3:8  doi:10.1186/1757-1146-3-8

Published: 17 May 2010

Abstract

Over the past decade there have been significant advances in the clinical understanding and care of rheumatoid arthritis (RA). Major paradigm changes include earlier disease detection and introduction of therapy, and 'tight control' of follow-up driven by regular measurement of disease activity parameters. The advent of tumour necrosis factor (TNF) inhibitors and other biologic therapies have further revolutionised care. Low disease state and remission with prevention of joint damage and irreversible disability are achievable therapeutic goals. Consequently new opportunities exist for all health professionals to contribute towards these advances. For podiatrists relevant issues range from greater awareness of current concepts including early referral guidelines through to the application of specialist skills to manage localised, residual disease activity and associated functional impairments. Here we describe a new paradigm of podiatry care in early RA. This is driven by current evidence that indicates that even in low disease activity states destruction of foot joints may be progressive and associated with accumulating disability. The paradigm parallels the medical model comprising early detection, targeted therapy, a new concept of tight control of foot arthritis, and disease monitoring.

'Podiatrists are experts on foot disorders: both patients and rheumatologists can profit from the involvement of a podiatrist'

- Korda and Balint, 2004 [1].