類風濕關節炎的藥物治療上，改善病情抗風濕藥（DMARDs）是常用的口服藥物(3)。甲氨蝶呤是一種類似葉酸的抗代謝物質，可抑制二氫葉酸還原酶以抑制 DNA 的合成，從而抑制細胞生長。甲氨蝶呤針對下肢的常見副作用包括下肢水腫，延長足部傷口癒合進度，以及增加感染風險等等。
(此資訊由 Lam Tsz Ho 會員撰寫)
Rheumatoid arthritis, a.k.a RA, is a chronic autoimmune and inflammatory condition that causes pain, swelling, deformities and stiffness in joints. The functional ability of RA patients could be affected significantly, thus it might lead to irreversible damages. In Hong Kong, it affects around 0.35% of the population, which is lower than that of other developed cities i.e. 0.5-1.0% (1). Statistics show that RA generally starts at the age of 30-50. Women are 3 times more likely to be diagnosed with RA than men.
The pathogenesis of RA consists of multiple genetic, environmental and immunologic factors (1). The etiology is uncertain and the trigger adaptive responses and interactions can undergo long before the onset of clinical symptoms. For RA patients, their immune systems mistakenly attack their own healthy cells.
Although any synovial joints in the body can be affected by RA, it usually affects the patient’s hands, feet and their wrists (2). Joint pain, joint swelling, toe deformities, plantar hyperkeratosis formation or even ulcerations and infections are some of the common presentations of RA feet. With RA, there are times when the symptoms get more serious, known as flares, and also times when the symptoms get milder, which is called remission.
RA-related medications and its manifestation to RA feet
RA patients are usually offered a combination of DMARDs (Disease modifying anti-rheumatic drugs) as a first-line treatment. Methotrexate is one of the common medications prescribed and it works by blocking the effects of chemicals released when the patients’ immune cells attack their own joints. However, this medication may potentially cause some side effects such as lower limb swelling and prolonged healing for foot and ankle ulcerations as it might increase vulnerability to damages and infections.
Role of podiatrists
The podiatrist role is here to provide timely clinical management for RA patients with various foot and ankle disorders. Clinical management includes identifying and treating the foot-related pain, skin care, ulceration care and providing insoles therapy if applicable (3). There are various types of insoles and orthotics that can be fitted into the shoes to relieve pressure and reduce friction for the feet. For RA patients who are suffering from joint deformities and foot ulcerations, the podiatrists are here to closely assess the wounds and provide suitable management.
It can be hard to deal with a chronic disease like rheumatoid arthritis. However, multidisciplinary team care could give the best care to RA patients. With podiatry care, the quality of life of them could be much improved. Please speak to your healthcare team if you are struggling to deal with your condition.
(This article is written by member Lam Tsz Ho)
1. Gov.hk. [cited 2023 Jan 13]. Available from: https://www.drugoffice.gov.hk/eps/do/en/consumer/news_informations/dm_30.html#a
2. Rheumatoid arthritis (RA) [Internet]. Cdc.gov. 2020 [cited 2023 Jan 13]. Available from: https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html
3. Rheumatoid arthritis - treatment. Rheumatology (Oxford) [Internet]. 1997 [cited 2023 Feb 20];36(suppl_1):174–93. Available from: https://www.nhs.uk/conditions/rheumatoid-arthritis/treatment/
4. Podiatrist [Internet]. NRAS. National Rheumatoid Arthritis Society (NRAS); 2020 [cited 2023 Jan 13]. Available from: https://nras.org.uk/resource/the-role-of-the-podiatrist-in-the-management-of-rheumatoid-arthritis/