Arthritis Take 2

Last week I discussed osteoarthritis and how it can affect the foot and ankle, but that is only hitting the surface when it comes to rheumatologic diseases and the foot. Rheumatoid arthritis, psoriatic arthritis, and other connective tissue diseases are just a few that can affect that foot and ankle. In this blog we will discuss these diseases, how they affect the feet, how they are diagnosed and most importantly how they are treated.

Rheumatoid Arthritis

Rheumatoid arthritis, also known as RA, is an autoimmune disease that affects synovial joints. It is a painful disease and without treatment it can cause severe disability. 85% of people with RA have symptoms in their ankle and foot joints. Joints with RA appear to be swollen, painful, warm and may become fused over time.  Below is a picture of RA in the hands, which causes severe swelling in the joints.

RA is different from osteoarthritis in that classic RA there appears to be stiff joints in the morning, whereas with osteoarthritis there are stiff joints throughout the entire day. With Osteoarthritis it gets worse over time and then becomes stable, RA becomes worse over time to a point where one cannot function or do daily life tasks.

Diagnosis is made with a multitude of test and via clinical exam. An x-ray of the feet during the mid to late stages of the disease may show subluxed/dislocation joints. In addition, there is decreased space within the joint and an increase in swelling around the joint. A blood test to test for Rheumatoid Factor can be performed, but a positive test doesn’t always mean there is RA and vica versa. During the course of diagnosis it is crucial to see a Rheumatologist, who can help rule out other autoimmune and rheumatologic diseases.

Treatment involves prolonging the disability that comes with the disease. Anti-inflammatory medications as well as disease-modifying antirheumatic drugs (DMAIRs) drugs are the mainstay of treatment. A Rheumatologist will prescribe and monitor these medications. Exercise is also important to help to decrease the symptoms and the disability of the disease.

RA in the foot causes lateral subluxation of the toes, this means that the toes tend to drift to the outside of the foot. Below is a picture where this can be seen.

This foot deformity can be prevented as the physician begins to see the toes are drifting. Once the deformity has occurred the best way to treat this is via surgery. The surgery will re align the joints that are causing the foot to deform. A foot like this can cause a great amount of pain, callus build up and can be very difficult for someone to find shoes.

In conclusion, rheumatoid arthritis is a systemic autoimmune disease that can affect all systems of the body and all aspects of one’s life. Early diagnosis is crucial to prevent long term problems. Concomitant care by your physician and by a rheumatologic specialist is critical for proper early treatment.

For more information on RA, visit http://www.arthritis.org/conditions-treatments/disease-center/rheumatoid-arthritis/

Next week I will conclude these series with Psoriatic arthritis and the feet.

For more information please visit our website, www.footnj.com