Diabetic foot in the context of rheumatic diseases: pathogenesis and treatment approaches

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Abstract
Diabetic foot is a frequent and debilitating complication of diabetes mellitus that significantly impairs quality of life and increases the risk of disability and amputation. This review examines the multifactorial pathogenesis of diabetic foot, focusing on its increased incidence and severity in patients with rheumatic diseases. The development of diabetic foot is driven by diabetic neuropathy, peripheral vascular disease, and infection. In patients with rheumatic diseases, chronic systemic inflammation and vascular dysfunction further accelerate tissue damage and impair wound healing. Long-term use of pharmacologic agents such as glucocorticoids and nonsteroidal anti-inflammatory drugs also contributes to metabolic imbalance, immune suppression, and vascular complications, increasing the risk of ulceration and infection. Rheumatic disease-related joint deformities and altered foot biomechanics add mechanical stress, exacerbating the condition. Effective management of diabetic foot in patients with rheumatic diseases requires a multidisciplinary approach. This includes early diagnosis, strict glycemic control, modulation of systemic inflammation, optimization of vascular health, and preventive foot care strategies. Addressing both metabolic and rheumatologic components is essential to reduce the risk of severe outcomes such as chronic infection and limb amputation. Understanding the interplay between diabetes and rheumatic diseases is crucial for improving clinical outcomes. Targeted, integrated interventions are key to preventing complications and enhancing the quality of life for affected patients.

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