Rheumatoid Arthritis
Overview:
Rheumatoid Arthritis is a systemic autoimmune disease which generally affects multiple joints throughout the body. Rheumatoid Arthritis results when an individuals immune system begins to attack and destroy cartilage, ligament and bone tissues which frequently results in joint deformities and bone fracture. In most cases RA will begin in the smaller joints and will have a bilateral presentation. When differentially diagnosing pathologies affecting the foot it becomes important to understand the signs and symptoms of RA. In 20% of patients with RA the signs and symptoms begin in the foot and ankle and nearly 90% of patients develop foot and ankle symptoms at some point in the disease progression. Causes: The exact causes behind RA is still unknown. Despite the understanding of the disease being autoimmune in nature, medical professionals are still unsure what triggers the disease. Some believe that there may be a genetic component due to higher incidence rates if other family members have also been diagnosed with RA. Women appear to be more prone to develop RA with an incidence in women nearly 3 times that of men. Symptoms generally begin to first appear after the age of 40. |
Signs/ Symptoms:
Symptoms generally are present bilaterally and often affect multiple joints. Loss of mobility and stiffness in various joints throughout the foot contribute to poor mechanics during ambulation and stance and my further contribute to joint deformities. Pain may become present due to degeneration and abnormal stresses being placed through the bony structures.
Medical Examination:
Treatment:
- Pain
- Stiffness
- Swelling
Symptoms generally are present bilaterally and often affect multiple joints. Loss of mobility and stiffness in various joints throughout the foot contribute to poor mechanics during ambulation and stance and my further contribute to joint deformities. Pain may become present due to degeneration and abnormal stresses being placed through the bony structures.
Medical Examination:
- Skin integrity looking for callouses and abnormal pressure distribution.
- Foot shape looking for bone deformities and irregularities.
- Flexibility and ROM
- Tenderness upon palpation to examine specific joints and specific locations of pain.
- Imaging (x-ray, CT Scan and MRI)
Treatment:
- Rest and modified exercise - In advanced stages rest becomes important in order to regulate pain and reduce stressors placed through the affected structures. Modified exercise interventions such as biking, elliptical training and swimming can allow the patient to maintain physical fitness without overloading the joints.
- Ice - May help with pain and inflammation. May be performed for 15-20 mins multiple times per day.
- NSAIDS - Drugs such as ibuprofen may help reduce pain and inflammation. Make sure to speak to your doctor prior to use.
- Orthotics - Orthotics can help displace pressure on prominent bones in the foot. The orthotic will not be able to correct the shape of the foot but can help reduce pain on prominent surfaces.
- Braces - A lace up ankle brace may be effective in reducing pain in the ankle or posterior foot.
- Steroid Injection - In the early stages of the disease a cortisone injection can help reduce inflammation within the joint.
- Surgical Treatment - Surgical fusion and realignment of bony deformities may be necessary.
References:
- Mayo Clinic. visited on July 12, 2014. http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/basics/definition/con-20014868
- American College of Rheumatology. visited on July 12, 2014. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/rheumatoid_arthritis/
Last Edited by: Jordon Cavanagh , SPT at AT Still University on July 12, 2014