RESEARCH - Interventions for foot disease in RA: a systemic review

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Arthritis Rheum. 2005 Aug 4;53(4):593-602 [Epub ahead of print]

Interventions for foot disease in rheumatoid arthritis: A systematic review.

Farrow SJ, Kingsley GH, DL.

Kings College, GKT School of Medicine, and Kings College Hospital, London,

United Kingdom.

OBJECTIVE: To systematically review medical and surgical foot intervention

studies in rheumatoid arthritis (RA), focusing on clinical efficacy, study

quality, and risk of harm. METHODS: We searched appropriate databases using

a combination of the terms " rheumatoid arthritis " and " foot " against terms

indicating treatment; we also hand-searched references. We selected articles

in English (1968-2003) comprising randomized controlled trials (RCTs),

controlled clinical trials (CCTs), prospective observational studies, and

large retrospective observational surgical studies (>50 cases). RCT quality

was examined using Jadad scoring; other designs were assessed qualitatively.

RESULTS: Inclusion criteria were met by 33 of 894 identified studies,

comprising 5 RCTs and 1 CCT (all nonsurgical), 15 prospective observational

studies (8 nonsurgical, 7 surgical), and 12 large retrospective studies (all

surgical). Functional, custom-designed and semirigid orthoses and

extra-depth shoes were effective in single RCTs of variable quality; no

comparative studies have been conducted. This finding was supported by a CCT

and prospective observational studies. There was no evidence of harm. There

were no controlled trials of surgery. Prospective observational studies

suggest that forefoot arthroplasty and first metatarsophalangeal joint

implants, but not plantar callous debridement, are effective. Comparative

retrospective analyses suggest that some procedure variants may be better,

and surgery may relieve pain better than orthoses. Infection was the main

risk. CONCLUSION: RCT evidence shows that orthoses and special shoes are

likely to be beneficial in patients with RA. The only evidence of benefit

from surgery comes from observational studies, because no RCTs have been

conducted. Further RCT evidence is needed, although well-designed

observational studies may be helpful.

PMID: 16082642

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6082642 & dopt=Abstract

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