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Table 2 Recommended early RA guidelines

From: Clinical practice guidelines for the foot and ankle in rheumatoid arthritis: a critical appraisal

Guideline Multidisciplinary team care AAccess to foot healthcare Foot health assessment/review Orthoses/insoles/splints Therapeutic footwear
Clinical practice guidelines for the use of non-pharmacological treatments in early rheumatoid arthritis [45]    Metatarsal pain and/or foot alignment abnormalities should be looked for regularly (GCP) Appropriate insoles should be prescribed if needed (GCP)  
BSR and BHPR Guidelines for the management of rheumatoid arthritis (the first 2 years) [47] Podiatry is part of the multidisciplinary team (GCP) Full-time dedicated podiatrist specialising in rheumatology is essential (GCP) Access to podiatry should be available according to patient need (GCP) Podiatry services should provide specific and dedicated service for diagnosis, assessment and management of foot problems associated with RA (GCP) Timely intervention for acute problems is important (GCP) Annual foot review and assessment is recommended for patients at risk of developing serious complications in order to detect problems early (GCP) Appropriate lower limb assessment for neurological and vascular status needed (GCP) Assessment of lower limb mechanics and foot pressures should occur (B) Orthoses are an important and effective intervention in RA (B) There should be a provision of specialist footwear if needed (B)
Clinical guidelines for the diagnosis and management of early rheumatoid arthritis [50] Podiatry is part of the multidisciplinary team (GCP) GPs should support access to appropriate foot care for patients with RA (GCP) Annual foot review and assessment recommended for patients at risk of developing serious complications in order to detect problems early (GCP) Appropriate foot orthoses are an important and effective intervention for RA (B)  
Management of early rheumatoid arthritis [51]     Custom made insoles can relieve pain (A) Orthopaedic footwear that offers sufficient comfort, mobility and stability (A)
SIGN 123 Management of early rheumatoid arthritis [53] Podiatry is part of the multidisciplinary team (GCP) ‘Good practice’ to offer all patients with early RA a podiatry referral (GCP)   Some evidence for the efficacy of foot orthoses for comfort, stride speed and stride length (C) Appropriate footwear for comfort, mobility, and stability is well recognised in clinical practice but little available evidence (GCP)
  1. A = Grade of recommendation based on systematic reviews; B = Grade of recommendation based on randomised controlled trials; C = Grade of recommendation based on quasi-experimental studies; D = Grade of recommendation based on non-experimental descriptive studies; GCP = Good Clinical Practice based on expert opinion