Condition Spotlight: Rheumatoid Arthritis in Feet

What is Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune disease whereby the body’s own immune system attacks the joints.

In severe cases of rheumatoid arthritis, the body’s organs can also come under attack.

Rheumatoid arthritis is sometimes mistaken for osteoarthritis, however they are quite different.

Whilst the exact cause of both diseases is unclear, osteoarthritis is not an autoimmune disorder, thus the cause of cartilage degeneration is believed to be mechanical. As explained previously, this is not the case in rheumatoid arthritis, where the body’s own cells cause destruction of the joint space.

Rheumatoid arthritis can result in painful movement of the joints due to a lack of cartilage, resulting in ‘bone on bone’ joint movement. Rheumatoid arthritis also causes lumps in the joints, due to a build up of a tissue called ‘pannus’ in the joint space, as well as inflammation causing an increase in fluid in the joint.

This is why people with rheumatoid arthritis will often have lumps all over their hands or feet.

 

What Causes Rheumatoid Arthritis? 

As we know, rheumatoid arthritis is caused by the body’s immune system turning on itself and attacking structures that make up a healthy joint.

A normal joint space is shown on the left side of the image below, and next to it is what a joint space looks like when affected by rheumatoid arthritis.

The white blood cells of a person with rheumatoid arthritis will release chemicals called cytokines, which will attack the synovial membrane of the joint and thus causing a tissue called pannus to form out of thickened blood vessels.

This tissue will invade and destroy other structures inside the joint space. Inflammation can then cause swelling of the joint capsule, which is why we see lumps surrounding the joints of people with rheumatoid arthritis.

Eventually this destruction of cartilage as well as other joint space structures will cause narrowing of the joint space, until the joint is simply one bone rubbing against another bone.

This can sometimes lead to what is known as ‘ankylosis’, which is when the two bones contacting each other begin to fuse together. This results in extremely limited or often no joint range of motion, resulting in a loss of function of the joint.

 

Types of Rheumatoid Arthritis

There are three main types of rheumatoid arthritis:

  • Juvenile rheumatoid arthritis – this type only affects children. The other two are known as
  • Seropositive rheumatoid arthritis – this means that the antibodies that can attack the joints are present in your bloodstream. It is the more common type of rheumatoid arthritis.
  • Seronegative rheumatoid arthritis – the antibodies are not detected in your bloodstream, however you are still displaying the symptoms of rheumatoid arthritis.

 

How is Rheumatoid Arthritis Diagnosed?

Rheumatoid arthritis is diagnosed using a combination of patient symptoms, subjective information and blood tests.

Some of the symptoms to look out for include pain, stiffness, deformity and swelling in the joints.

The second step involves a series of blood tests. Firstly, you will be tested for the presence of rheumatoid factor. As discussed previously, rheumatoid factor is not always present in those with rheumatoid arthritis, however it can give a doctor an idea of how aggressive the treatment needs to be. This is considered an old test now, so luckily a new test that gives much more accurate data has been created.

Testing for the presence of C reactive protein, or ‘CRP’ gives a much better indication of the presence of rheumatoid arthritis. If a person tests positive for CRP, they most likely have rheumatoid arthritis, however, a person that tests negative for CRP may still have rheumatoid arthritis.

This is why understanding a patient’s symptoms are so important when it comes to diagnosing rheumatoid arthritis. Other tests such as testing for inflammatory markers in the blood or joint may be used, but all of these tests must be combined with the presence of the correct symptoms for the diagnosis of rheumatoid arthritis to be made.

 

How is Rheumatoid Arthritis Treated? 

There are multiple options when it comes to treatment of rheumatoid arthritis and early intervention is key in ensuring symptoms improve.

However, while there are treatments available, it is important to understand that there is no ‘cure’ for rheumatoid arthritis.

The treatment options that are available include:

  • Medications. These can include anti-inflammatories, steroids, or DMARDs (Disease modifying anti-rheumatic drugs).
  • Heat packs – these can help to reduce inflammation and loosen up the joints slightly.
  • Stretching, strengthening and range of motion exercises – these can help to maintain movement and reduce strain on other parts of the body.

 

How Can We Help? 

Podiatrists are able to help in the treatment of rheumatoid arthritis in a variety of ways. This can include:

Assisting with stretching, strengthening and range of motion exercise plans.

Provide general skin and nail care – often patients with rheumatoid arthritis will suffer from deformities on their hands as well as their feet, making simple tasks like cutting their toenails properly difficult. Due to the deformities of the toes, the nails may also become thick and painful and require regular treatment. Podiatrists are able to help manage your general foot care to help avoid further problems or complications.

Treats corns and calluses that occur as a result of rheumatoid arthritis – As rheumatoid arthritis, joint deformity is almost a given. This can result in excessive pressure placed on different parts of the feet, including on the bottom of the forefoot and the tops of the toes. Management of these can include regular debridement and treatment, the use of simple devices to protect the toes or orthotics to help reduce pressure.

Come see us at Watsonia Podiatry

If you have rheumatoid arthritis, or any condition affecting the health of your feet and/or lower limbs that is causing you pain or discomfort, come see us here at Watsonia Podiatry. We have a team of podiatry superstars who are here to help you take care of your feet and keep you out of pain.

Book an appointment to see us by calling us on 03 9432 2689 or booking online here.

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