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Connective tissue diseases - a podiatry focus

Connective tissue diseases - a podiatry focus

Sarah McBride
Specialist Podiatrist, Rheumatology Service
Dorset Healthcare University NHS Foundation Trust

This informative MSK session focused on connective tissue diseases and how they may affect the feet and lower limb. Chaired by Robert Field, it presented an excellent opportunity to gain more knowledge on the lesser known connective tissue diseases which are becoming increasingly prevalent within the rheumatology sector. On the day it was encouraging to see the room so full and the presentations and discussions did not disappoint.

The aim of the session was to establish a greater understanding and awareness of these complex syndromes with their underlying pathologies and to highlight the range of conditions we may come across in clinic as podiatrists.

The first presentation was by consultant rheumatologist Dr Ciaran Dunne, who focused on the vascular pathologies and the foot in the connective tissue disease. Dr Dunne gave a broad overview of vascular pathologies with the importance of the risk factors involved. He explained the metabolic syndrome in a way which was easily understood and emphasised connective tissue disease as being a multi-factorial syndrome involving a number of these risk factors. He described each factor as being ‘controllable’ or ‘uncontrollable’. There was an interesting link with regards to controllable factors. In clinic we actively try to alter these risk factors with patients with, for instance, diabetes by encouraging exercise, a healthy diet, etc, but are we ensuring our advice and education concerning these factors is reaching those with connective tissue diseases?

Another point Dr Dunne made was that for people with rheumatoid arthritis, it is the associated vascular disease element that is a higher cause of death than rheumatoid arthritis itself. This is worth noting when we carry out vascular checks within clinics and it may encourage a more thorough assessment of the lower limb for the early detection of complications.

The second speaker, consultant rheumatologist Dr Jonathan Marks focused on an overview of connective tissue diseases with emphasis on the lower limb. Dr Marks delved into more detail around connective tissue diseases and how they can affect the lower limb. His aim was to increase the awareness of these conditions within our clinics and to help us to recognise the features of an at-risk digit or limb. Digital threatened ischaemia is a particular risk within inflammatory arthritis and connective tissue disease and Dr Marks emphasised how this can apply to upper and lower limb. He then explained referral pathways and stressed the importance of good relationships across multiple disciplines and teams in order to manage complications and provide the best outcome for the patient.

Robert Field concluded the session with a presentation on systemic sclerosis including case studies. Some of the case studies he presented were met with audible gasps as photographs showed the shocking outcomes systemic sclerosis can cause, from contractures of the digits to extensive necrosis of the hands. Robert explained that a significant proportion of the rheumatology-based podiatry team’s clinical work involves the upper limb although the lower limb can be involved, which shows how our specialist podiatry skills can be transferable in managing wounds.

Robert highlighted the intensity of the treatment required and quoted the high numbers of clinical contacts, often seeing the majority of these patients weekly. He also advised regular reviews on pain level management due to the nature of these incredibly tender lesions as well as touching on how this condition can severely impact a patient’s simple daily tasks.

To conclude, this session highlighted the common and restricting nature of these conditions and how we as podiatrists can support, inform and educate our patients. As podiatrists we may see these patients on a more frequent basis, thus we can act as the eyes and ears for the rheumatology consultants and practitioners. We can potentially prevent life changing complications and provide an opportunity for patients to have the best possible outcomes.