Rheumatology:
Guided Revision – Rheumatology
1. Write a definition for RA. How would the definition for a sero-negative or crystal arthropathy differ from this?
2. What features might a patient present with that would suggest they had RA? Consider features you might look for in their medical history as well as general signs and symptoms.
3. What features would they present with if they had a sero-negative arthropathy (you chose one)? What features would they have if they had gout?
4. How would you recognise RA in the foot if a patient presented? Name a features that is commonly seen (ie. Bursitis) and state how the structure is affected (ie. Development of bursae over met heads in response to overloading associated with development of toe deformities, fatty padding atrophy and inflammation synovial lining of bursa). Use the table below:
articular Extra articular
Rearfoot
Midfoot
Forefoot
5. Compare these features in a sero-negative condition such as psoriatic arthritis:
6. Compare these features in gout (a crystal arthropathy):
7. What X-ray features would you expect to see if you had a patient presenting with an arthropathy? Complete the table below:
RA Psoriatic arthritis Gout
1st mtp joint
8. What would be the medical management for a patient who had a recent diagnosis of RA? Compare this with a sero-negative case and compare this with gout.
9. What would be the podiatric management of a patient with RA? Compare this with a sero-negative arthropathy (of your choice) and with gout.
10. Orthoses are frequently used in the podiatric management. What is the difference between an accommodative device and a functional device? When would you use one type in preference to the other? Consider your answer in terms of what the aim of the devise is and what you hope to achieve?
11. Specifically for the foot in RA, list the features (articular and extra articular) described in the table in Q4 and describe how orthoses (accommodative and functional) might be helpful for these features of the disease. You should think about the materials you would prescribe for the orthoses or details on the shape that would be relevant to a prescription.
12. Part of the long term management might be for a patient to have surgery. For example an RA patient might need forefoot surgery for HAV or toe deformities. Consider in which situations a patient would be suitable for surgery and when no (indications and contra-indications). Give an example of a hallux valgus procedure and a toe deformity procedure that might be undertaken.