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The main theme of this thesis is foot and ankle complaints in patients with RA. This choice results from the practical observations that often as clinical routine, the disease activity is determined by means of computing a DAS 28. That means that the feet and or ankles don’t have to be examined during the visit. There are other reasons to avoid the feet. For patients, it is often laborious to take off their shoes, especially when it concerns customized shoes, or when due to hand damage, unlacing and taking off the shoes lasts minutes. Feet often smell more or less, which is annoying for the rheumatologist and uncomfortable for the patient. The neglect of feet in clinical practice prevents targeted treatment and may lead to untimely referral to podiatrist or orthopaedic surgeon, or to late dose adjustment of the DMARD therapy. Unnecessary inflammation and or damage can be the result. In order to form hypothesis on the nature of and the sequences of events in foot involvement, we conducted a pilot study with thirty outpatient clinic RA patients. All patients underwent clinical examination, then additional imaging studies were performed (ultrasound, X-ray and MRI) and patients filled in questionnaires. Afterwards, gait analysis was performed in all patients. The obtained data could not be presented in one publication, hence the result of our study that was meant to create hypotheses. The results of gait analysis are published in separate PhD thesis of engineer, Mrs. R.Dubbeldam. |
