Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0003873 (rheumatoid arthritis)
 53,068 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A conservative approach to foot problems is especially useful in patients with diabetes, rheumatoid arthritis, diminished circulatory changes, and those who are too debilitated for surgical treatment. If one will start with either the medial heel wedge or the anterior heel correction, some response should be evident within 4 to 6 weeks. If the response after a trial period of approximately two to three months for a heel wedge or another two to three months for the anterior heel doesn't relieve pain, then perhaps some other problem might now become easier to localize, i.e. Morton's toe syndrome, hallux valgus, soft or hard corns, or hammertoe deformities. When the anterior heel is prescribed many foot problems other than metatarsalgia will stop being symptomatic and surgery treatment can be bypassed. A physician must know about the supply of shoes in the community and, if necessary, instigate a better inventory of available shoes. In addition, it is necessary to establish good rapport with the shoe repair man so that he will not intrude in your patient rapport or alter your directions. Patients also need advice about losing weight. Frequently a loss of 15 or 20 pounds will change a patient's complaint from one of extremely discomforting daily weight-bearing to a tolerance of a fair amount of walking and at least a reduction of the complaints to a more endurable and functional level. One can't expect the shoe correction to do everything for everyone. The anterior heel isn't the whole solution to the complicated problem but it helps to have patients begin to see results in more comfort in their shoe wear.
 ...
PMID:The anterior heel for metatarsalgia in the adult foot. 85 20

Many of the fair and poor results are directly traceable to errors in technique. Patient selection is also important. The operation can be done in adolescents since there is no growth plate at the distal end of the first metatarsal. We do not currently recommend this procedure for those over 60, for those with first metatarsophalangeal osteoarthritis or hallux rigidus or for those with moderate or severe rheumatoid arthritis. For these patients we usually do a Keller excisional arthroplasty. Our use of the osteotomy-bunionectomy operation for the patient with hallux valgus with an associated metatarsalgia or short first metatarsal has now become more cautious. We feel that the operation is not indicated for those with significant preoperative metatarsalgia, especially if the first metatarsal is shorter than the second, or for those whose first metatarsal is more than 4 or 5 millimeters shorter than the second, regardless of preoperative metatarsalgia. In these patients a McBride procedure or a proximal opening-wedge osteotomy is done.
 ...
PMID:The Mitchell distal metatarsal osteotomy in the treatment of hallux valgus. 113 79

Pain in the foot and ankle is most frequently secondary to static and degenerative changes, eg, corns, hammer toes, bunions, anterior metatarsalgia, and heel pain. A second common group consists of rheumatologic disorders that encompass immune and hereditary factors. This group includes rheumatoid arthritis, the often underdiagnosed seronegative spondyloarthropathies, and, less commonly, crystalline deposit disorders and diffuse connective tissue diseases. Both the physician and the public need a heightened awareness of the existence and presence of these disorders, which may be devastating, eg, psoriatic arthritis and tenosynovitis. To these groups, we now must add Lyme disease and acquired immunodeficiency syndrome. The advances in testing, including immunologic and nuclear imaging (eg, magnetic resonance imaging), have permitted more rapid and specific diagnosis with earlier treatment.
 ...
PMID:Foot and ankle pain resulting from rheumatic conditions. 158 Nov 52

Authors discuss, presenting case reports, the operative indications of Helal's metatarsal serial osteotomy. In their first case this kind of operation was performed because of metatarsalgia, following traumatic amputation of the hallux. In their second case, in a young female with rheumatoid arthritis, considering the age of the patient and the destruction in the metatarsophalangeal joints too, Helal's metatarsus osteotomies were completed with the resection of the basis of the ground phalanx. In both cases good correction was reached and without any complaints.
 ...
PMID:[Special indications for Helal's serial metatarsal osteotomy]. 197 65

The differential diagnosis for metatarsalgia should include rheumatoid arthritis, SLE, mixed connective tissue disease, psoriatic arthritis, Reiter's syndrome, fibromyalgic syndrome, gout, post-traumatic joint disease, and septic arthritis. When the patient's symptoms are approached systematically an accurate diagnosis can lead to implementation of an appropriate treatment plan. Multidisciplinary treatment approaches often lead to the most satisfying therapeutic outcomes.
 ...
PMID:Lesser metatarsalgia. Rheumatologic considerations. 225 74

We reviewed the results of the Keller arthroplasty in combination with resection arthroplasty of the forefoot in patients with rheumatoid arthritis. Of the 29 patients (49 feet) in the series, 20 had involvement of both feet and nine had involvement of a single foot. The average age of the patients was 55.4 years, and the average follow-up period was 4.9 years. All feet had resection of the lesser metatarsal heads, resection of the base of the proximal phalanges of the lesser toe, and a Keller arthroplasty of the first metatarsophalangeal joint. The results were satisfactory in 16 feet, satisfactory with some reservations in 21 feet, satisfactory with major reservations in seven feet, and unsatisfactory in five feet. For 40 of the 49 feet (82%), the patients stated that they would repeat the procedure, knowing the results achieved. The major causes of patient reservations and lack of satisfaction were return of the hallux valgus deformity and pain (53%), forefoot instability (27%), and continuing metatarsalgia (20%). Resection arthroplasty of the lesser metatarsophalangeal joints of the forefoot in rheumatoid disease is a satisfactory procedure. When used in combination with Keller resection arthroplasty of the first metatarsophalangeal joint, however, an increased number of unsatisfactory results occur, attributable to returning pain and deformity of that joint.
 ...
PMID:Keller arthroplasty in combination with resection arthroplasty of the lesser metatarsophalangeal joints in rheumatoid arthritis. 322 2

Forefoot arthroplasty is often recommended for the management of metatarsalgia secondary to rheumatoid arthritis. Concurrently, the first metatarsophalangeal (MP) joint can be fused rather than excised. The results in 37 patients with 64 arthroplasty operations (34 with fusion and 30 with excision of the first joint) show that fusion produced a better cosmetic appearance of the foot, facilitated fitting with normal shoes, and improved overall balance. Pedobarograph measurements during gait indicated that relatively more weight was transmitted through the medial ray when the first metatarsophalangeal joint was fused. Residual pain in the foot was often caused by irregular trimming of the metatarsals. There was no difference in relief of pain between fused and unfused patients. Failure of fusion at the first metatarsophalangeal joint generally was painless. Radiologic degeneration of the interphalangeal (IP) joint of the great toe was relatively common following fusion. MP joint fusion is inadvisable if there is already disease in the IP joint.
 ...
PMID:Fusion of the first metatarsophalangeal joint in forefoot arthroplasty. 648 39

A review is presented of 508 feet in 310 patients after telescoping osteotomy of the lesser metatarsals for metatarsalgia. The patients were predominantly female (80%), with a mean age of 55 years; the range of follow-up was 1 to 12 years. In 22% of the patients the metatarsalgia was associated with rheumatoid arthritis. Improvements in assessment and modifications in technique are reported and the management of complications is discussed. The results show that telescoping osteotomy for established cases of pressure metatarsalgia is a simple and reliable operation. Permanent relief of symptoms can be expected in over 80% of patients.
 ...
PMID:Telescoping osteotomy for pressure metatarsalgia. 670 57

In a retrospective survey of 65 patients who had rheumatoid arthritis, the late results of excision arthroplasty of the forefoot were investigated and compared with nonoperative management. Subjective assessment of foot shape and severity of pain as well as objective changes in gait and deformity were considered. Surgery relieved pain initially, but the recurrence rate of metatarsalgia was high. In those who wore surgical shoes, lack of cosmesis was the most important factor in determining poor compliance. The operation was recommended at random, and there was little difference in the outcomes of nonoperative and surgical treatments. A long-term randomized prospective trial is required to establish the criteria for selection of a management regime.
 ...
PMID:Management of the deformed rheumatoid forefoot. A comparison of conservative and surgical methods. 708 58

Thirteen patients (14 feet) were treated for mild rheumatoid forefoot deformities with lesser toe partial proximal phalangectomies and partial syndactylizations. Eleven patients (85%) were reviewed at an average of 8 years postoperatively. The results were completely satisfactory in four patients, satisfactory with minor reservations in three patients, satisfactory with major reservations in one patient, and unsatisfactory in three patients. The major cause of reservations and lack of satisfaction was metatarsalgia. Seven patients (64%) reported that their activities were limited by intermittent metatarsalgia. Four patients (36%) considered the cosmetic appearance of the forefoot to be unsatisfactory. All but one patient required some form of shoewear modification. Based on this study, we believe the indications for this procedure are limited. These include rheumatoid patients with mild forefoot deformities without significant metatarsalgia or ongoing disease who have failed nonoperative treatment. Relative contraindications to this operation appear to include the recent onset of rheumatoid arthritis, active disease, significant metatarsalgia, and strong cosmetic concerns regarding outcome. In borderline clinical decisions that involve whether or not to leave or excise the lesser metatarsal heads, they probably should be excised to decrease late metatarsalgia.
 ...
PMID:Surgical treatment for mild deformities of the rheumatoid forefoot by partial phalangectomy and syndactylization. 840 47


1 2 Next >>