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In inflammatory disease their exact mode of action is unknown but they inhibit the migration of leukocytes and proliferation of lymphocytes in rheumatoid arthritis. They also reduce release of enzymes in phagocytic cells and inhibit phospholipase A prostaglandin and leukotriene synthesis. Chloroquine and hydroxychloroquine are sometimes used to treat systemic and discoid lupus erythematosus, but should not be used for psoriatic arthritis. Because of the risk of retinopathy, long-term therapy should be reserved for cases in which all other DMARDs have failed. Immunosuppressants, such as azathioprine, ciclosporin and methotrexate, can be used to treat severe inflammatory disease.

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The result of this is a slowing of the heart rate. Indeed lidocaine is used for this purpose in the treatment of ventricular arrhythmias. Local anaesthetics cause varying degrees of vasodilation. The combination of a fall in heart rate and peripheral vasodilatation can result in a fall in blood pressure and fainting.

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All are treatable with drug therapy and possibly changes in lifestyle as well. Health care professionals, in the course of their professional practice, are sure to come across patients on the drugs commonly used in these conditions. Some of them are of particular significance to podiatric practice. A basic knowledge of the clotting mechanism, the causes and consequences of anaemia and lipid metabolism is needed in order to appreciate how these conditions can be treated.

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Authored by Dr. Kevin Kucko, MAPT


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