Timothy M. Spiegel

Rheumatoid arthritis in the foot and ankle--diagnosis, pathology, and treatment. The relationship between foot and ankle deformity and disease duration in 50 patients.

Rheumatoid arthritis frequently results in synovitis and deformity of the ankle and foot. Rheumatoid vasculitis presents with skin ulceration, digital ischemia, nodules, and mononeuritis multiplex. The relationship of disease duration and deformity is discussed in 50 patients with rheumatoid arthritis.

Are rehabilitation programs for rheumatoid arthritis patients effective

H ISTORICALLY, treatment for rheumatic diseases has been recognized since the Roman use of the natural springs of Bath, England, in 300 AD.’ In modern medicine, the disabling consequences of rheumatoid arthritis (RA) are still well recognized and rehabilitation programs for these patients have evolved.2-4 These programs are multidisciplinary efforts aimed at preserving the patients’ quality of life by improving functional ability, mental and social health, vocational status, and disease activity. Riggs and Gall’ recently identified the components of this team treatment approach in their state-of-the-art discussion of arthritis rehabilitation. Many health professionals and patients are zealous supporters of these programs, claiming that they actually produce substantial improvements. However, strong endorsement for these programs is not universally shared, partially because the scientific community has been slow to establish their effectiveness. Do these intensive programs truly produce these benefits, or would many patients with standard care and the passage of time achieve similar improvements? Although rheumatologists are familiar with the principles of arthritis rehabilitation, many believe that medications account for most improvements. Consequently, many of these physicians refer few patients to rehabilitative programs or for routine evaluation and treatment by allied health professionals. Few primary care physicians have more than a vague idea regarding the principles or benefits of multidisciplinary rehabilitative programs or the services provided by allied health professionals.’