Rheumatoid Arthritis

This is a condition that can affect any joint in the body and is progressive and autoimmune in origin. RA is more common in women than men and begins between the ages of 25 and 60. It occurs when the immune system attacks the joints and the surrounding tissues causing pain, inflammation, and eventually, disability in the joints. During “flares”, an active phase of RA, the joints become inflamed, red, hot, and painful.  Since joints in the feet are often affected when RA is present, it has a major effect on gait, balance, ability to walk, and may cause restrictions in activities of daily living. Joints in the neck, jaw, ankles, knees, hips, shoulders, and elbows can also be affected.

     Following the trigger for the autoimmune reaction, which is unknown, inflammatory cells penetrate the joint filling it. In addition, inflammatory chemicals erode cartilage, bone, ligaments, and articular capsule. This is followed by synovial fluid build-up in the joint resulting in pain and swelling. Then, the following sequence of events occurs: synovium becomes thick and changes into a tissue called “pannus”, it releases inflammatory mediators that damage cartilage and bone under it, thick scar tissue develops that, eventually, causes the bone ends to fuse together. Bone fusion does not occur in all cases of RA.

     RA causes symptoms inside and outside the joints. Inside the joints, it affects synovium, a thin layer of tissue that lines the joints throughout the body. Other symptoms of RA include fatigue, joint pain, morning stiffness, and swelling in the joints furthest away from the body, such as the wrists and the feet in a symmetrical pattern. Outside the joint, the symptoms include muscle weakness, decrease in muscular strength and mass, anemia, myalgia, malaise, swollen glands, loss of appetite, weight loss, and low grade fever.

     In order to protect the joints and prevent the disease from getting worse, it is important to treat RA early. To this end, medications and lifestyle changes are used. Drug therapy for RA includes disease-modifying antirheumatic drugs (DMARDs), non-steroidal anti-inflammatories (NSAIDs), and steroids. Other treatment options are foot orthotics, specialty footwear, analgesics, occupational and physical therapy, splinting, and alternative therapies. If advanced disease is present, orthopedic surgery may be indicated.

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