Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory joint destructive disease. It is one of several types of arthritic conditions.

Symptoms of rheumatoid arthritis are pain and swelling in and around joints. Frequently on the foot it involves the metatarsalphalangeal joints or the ankle. Both the right and left foot are commonly affected at the same time. The joints can be very stiff in the morning and usually improve as the day continues. There may be rheumatoid nodules over bony points. There may be systemic symptoms associated with rheumatoid arthritis such as fever, and fatigue. Women in the age of 40-60 are more commonly affected than any other group, although anyone can be affected.

Causes of rheumatoid arthritis are not clearly understood. It involves the reaction between the IgM antibody and the IgG antigen substrate. Basically, the IgG antibody is thought of as a foreign substance in your body and the body tries to attack it producing inflammation. Long term inflammation of the synovium (joint fluid) produces damage of the joint and associated pain. Many theories exist as why this happens which includes genetics, bacteria, or viral agents.

Diagnosis of rheumatoid arthritis is based mostly on clinical symptoms. The American Rheumatism Association has guidelines that must be met before an actual diagnosis of rheumatoid arthritis is made. Diagnosis is made if 4 of the following 7 conditions exist.

    1. Morning stiffness around the joints lasting at least one hour before improvement for at least 6 weeks.

    2. Arthritis of at least 3 or more joint areas for at least 6 weeks.

    3. Arthritis of hand joints for at least 6 weeks.

    4. Symmetric arthritis, the same joints are affected on both sides of the body for at least 6 weeks.

    5. Rheumatoid nodules clinically observed.

    6. Serum rheumatoid factor detected by testing the blood.

    7. Radiographic changes detected by your physician using x-rays.

Podiatric Care involves exercises designed to maintain joint flexibility, retain muscle tone, and preserve the strength of ligaments and tendons. Orthotics, custom molded shoes, or modifications of existing shoes is usually used to accommodate foot deformities, or rheumatoid nodules to provide relief and improve the quality of daily life. Limited use of a corticosteroid joint injection may be tried and of some value, as well as short term use of a non-steroidal anti-inflammatory. Other medications are used for treatment of rheumatoid arthritis but you will usually be referred to a rheumatologist for careful monitoring, while your podiatrist maintains the foot structure and its complications.

Surgery for patients with rheumatoid arthritis can be helpful to improve the daily living and relief of pressure. This type of surgery is generally a reconstructive surgery and not completed to make the foot “normal”. Sometimes implants can be used as joint spacers in certain conditions. Simply removing a nodule surgically will not guarantee it will not return.