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What is rheumatoid arthritis?
Causes & risk factors
Symptoms
Diagnosis
Treatment
If you ignore rheumatoid arthritis
Prevention
FAQs

Living with rheumatoid arthritis can be taxing on a person’s mobility and quality of life, especially if they’re experiencing significant joint deformities and swelling in their feet. Our Brisbane podiatrists have a range of therapies and management strategies to best support those with rheumatoid arthritis and help optimise their mobility, so they can keep doing the things they love.

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a long-term autoimmune condition that affects your body by persistently attacking the lining of your joints, ultimately leading to their damage and deterioration. Unlike the wear-and-tear damage of osteoarthritis that happens with use over time, this occurs when the immune system doesn't work properly, mistakenly attacking your own healthy cells. 

One of the distinguishing factors of rheumatoid arthritis is its symmetry, affecting the joints on both the left and right side of your body and across multiple joints. This is vastly different to osteoarthritis, which is commonly unilateral and isolated to minimal joints, or gout where only very few joints are affected - often only the big toe joint on one foot. 

The joints commonly involved in rheumatoid arthritis include the small joints of your hands and feet, knees, hips, ankles, elbows and shoulders. In some people, the disease will affect more than just your joints, and may cause damage to your skin, eyes, lungs, heart and blood vessels. 

Causes And Risk Factors

For most people, your immune system serves to defend your body against infection. With rheumatoid arthritis, your immune system malfunctions and mistakes your body's cells for invaders - attacking them instead. This results in the release of inflammatory chemicals that attack the synovium, the soft tissue that lines the joints and produces a fluid that helps your joints move smoothly and without friction. When the synovium becomes inflamed, it thickens, causing the area to feel painful and tender, become red and swollen, and it can even minimise movement around the joints leading to stiffness and difficulty bearing weight on the joints.

Over time, this process eventually deteriorates the cartilage and bone within the affected joints. Additionally, the tendons and ligaments responsible for supporting and stabilising your joints will weaken and stretch, causing the joint to lose its shape and alignment - leading to deformed and disfigured joints that can make it difficult to walk or find well-fitting footwear.

It is not currently known why your immune system decides to attack your body instead of the intruders. Researchers believe it could be connected to your genetics paired with environmental or other triggers. This means that having certain genes, when activated by an environmental trigger, such as a virus or bacteria, may trigger the disease. 

Factors that may increase your risk of developing rheumatoid arthritis, including:

• Age: while rheumatoid arthritis can affect anyone at any age, it is more likely to begin between the ages of 40 and 60 years old
  
• Gender: notably more women than men suffer from rheumatoid arthritis. 
  
• Family history: although it's not considered a hereditary disease, If a family member has rheumatoid arthritis, then you have a higher risk of developing the disease too.
  
• Smoking: there is some evidence that suggests people who smoke have an increased risk of developing rheumatoid arthritis. It's also suggestive that it increases the severity of the disease.
  
• Obesity: obesity has also been associated with an increased risk of developing rheumatoid arthritis, and may also impact disease progression and treatment response.
  
• Infections: some infections, such as certain bacteria or viruses, may trigger an immune response that could increase the risk of developing RA, especially in individuals with a genetic predisposition.
  
• Environmental exposures: the prolonged exposure to certain environmental factors, such as silica or asbestos, has been linked to an increased risk of rheumatoid arthritis.
  
• Hormones: hormonal factors, including pregnancy and menopause, may influence the risk of rheumatoid arthritis, as the disease activity can fluctuate during these stages.
• Having other autoimmune conditions: if you also suffer from other diseases such as lupus or psoriasis, you may have a higher risk of developing rheumatoid arthritis.

Symptoms

Symptoms of rheumatoid arthritis can vary greatly from person to person, ranging from mild to severe. In the early days of the disease, you may not see large amounts of swelling or redness, however, you are still likely to experience pain and tenderness. As the inflammation continues and the joint damage accumulates, you may start to notice visible changes in the stiffness, structure and function of your joints. General signs and symptoms include:

• Joint pain, swelling and tenderness
  
• Stiffness that is usually worse in the morning
  
• Multiple joints are affected
  
• The same joints on both sides of the body are affected (symmetrically)
  
• Small, firm bumps called rheumatoid nodules may develop under the skin, typically near joints.
  
• Muscle and joint pain may be accompanied by fatigue, fever and loss of appetite 
  
• General fatigue and a feeling of exhaustion are common, often due to the body's inflammatory response
  
• Prolonged morning stiffness, lasting for more than 30 minutes upon waking.
  
• In its later stages, the loss of joint function, limiting your mobility and affecting daily activities.
  

Rheumatoid arthritis will mostly affect the smaller joints first, particularly the joints that attach your fingers to your palms and toes to your feet. It may then spread to your larger joints including your knees, hips, ankles, elbows, shoulders and wrists. These symptoms will often appear as flare ups or exacerbations, when you're experiencing a lot of inflammation and other symptoms. These can last for days or months, and are usually followed by periods of apparent remission, when the swelling and pain seem to disappear. 

Diagnosis

Rheumatoid arthritis can be difficult to recognise and diagnose in its early stages as the early symptoms mimic those of many other conditions and diseases. Due to this, and the fact that early interventions can help optimise your comfort and mobility over the years, it’s important to get an accurate diagnosis early.

Diagnosing rheumatoid arthritis starts with getting a detailed look into your medical history and then completing a comprehensive physical examination of your symptoms; particularly looking for tender and warm joints, localised joint inflammation and pain during joint movement, bony alignment change and reduction in joint movement. If rheumatoid arthritis is suspected, the next step is a referral for blood tests that will look for inflammation and the presence of specific blood proteins. Your GP may also need to carry out additional testing, such as:

• Rheumatoid factor test
• Anticitrullinated peptide antibody test
• Antinuclear antibody test
• Erthrocyte sedimentation rate
• C-reactive protein test

Our podiatrists may also request an x-ray, ultrasound or MRI to reveal any joint damage and the extent of it, as rheumatoid arthritis can cause the ends of the bone to wear down. If no damage shows up in these first tests, that may confirm the disease is in an early stage that hasn't damaged the bone yet. This is valuable information for your podiatrist to know in terms of developing a tailored management plan that will best support your joints, feet and legs. 

Rheumatoid Arthritis Treatment

GP Treatment

While there is currently no “cure” for rheumatoid arthritis, the symptoms can definitely be managed and reduced when detected early and treatment is started. Effectively managing rheumatoid arthritis means working with a multidisciplinary care team that may involve your doctor, rheumatologist, podiatrist and other health professionals. Many people diagnosed with rheumatoid arthritis will be prescribed medications such as non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), janus kinase inhibitors (JAKs) and corticosteroids. These can go a long way in helping reduce episodes of significant swelling, pain and discomfort.

Podiatrist Treatment

Regardless of whether your rheumatoid arthritis is in its early stages or if notable joint damage has occurred, there is a lot that our podiatrists can do to help optimise your comfort on your feet, your mobility and your quality of life. Our Brisbane podiatrists work extensively with those with rheumatoid arthritis, using therapies and management strategies including: 

• Footwear modifications and recommendations: your shoes will play an important role in helping keep you comfortable and mobile when living with rheumatoid arthritis. We can both recommend ideal shoes given your foot type and any foot problems or deformities you’re experiencing, as well as make custom modifications to your footwear to ensure they’re doing their best in optimising your comfort and quality of life. In many cases, helping keep your feet and joints supported and comfortable early on can help slow the progression of your symptoms.
  
• MLS laser: we use MLS laser extensively to help with relieving pain and improving your mobility and function when living with arthritis. The MLS laser works to reduce inflammation and pain, accelerate tissue repair and improve joint mobility, making it a perfect companion in managing your arthritis symptoms. You can learn more about how laser works specifically on arthritis pain here.
  
• Custom foot orthotics: in some cases, when your joints have sustained significant damage or you have some biomechanical factors associated with your feet and legs that may be exacerbating your symptoms or discomfort, we may recommend using custom-designed foot orthotics. These orthotics are created in a way that is specifically prescribed by your podiatrist, so are able to help with everything from relieving pressure from swollen or deformed joints to increasing specific areas of support or cushioning to optimise your comfort and function on your feet.
  
• Ankle foot orthotics (AFOs): AFOs can help those with rheumatoid arthritis by providing stability, support, and pain relief for affected foot and ankle joints. By wrapping around and stabilising the ankle, reducing pressure on inflamed joints, and improving gait mechanics, AFOs alleviate pain, prevent joint deformities, and enhance mobility, making it easier for individuals with rheumatoid arthritis to perform daily activities and maintain a better quality of life. The AFOs we offer are custom prescribed, designed to address a person’s unique foot and ankle needs.
  
•  Physical therapy: our podiatrists can show you a range of modified exercises to maintain strength and flexibility of the affected joints.
  
• Joint mobilisation: in the early stages of psoriatic arthritis, you may experience some joint restrictions that affect your comfort and mobility but are still relatively flexible. These can be ‘mobilised’ by your podiatrist into a better alignment or position to support greater comfort and movement on your feet.
  
• Personalised advice and recommendations about how to best manage your foot health.
  

What Can Happen If I Ignore Rheumatoid Arthritis?

If left untreated, rheumatoid arthritis can cause a number of complications including, but not limited to:

• Increased levels of joint pain
  
• Fatigue and fever 
  
• Increased risk of infection
  
• Increased deterioration of your cartilage and bones
  
• Persistent inflammation can mean a shorter lifespan 
  
• Increased risk of heart disease
  
• Skin issues
  
• Bone thinning
  
• Eye complications
  

Prevention

Although not knowingly preventable, there are a few things you can do to decrease your risk of developing rheumatoid arthritis:

• Maintain a healthy weight through regular exercise and a balanced diet
  
• Avoid smoking and limit exposure to secondhand smoke
  
• Be mindful of infections and promptly treat any infections
  
• Be aware of family history, especially if there is a history of rheumatoid arthritis or autoimmune diseases.
  
• Practise good hand and joint hygiene to reduce the risk of infections
  
• Stay physically active with low-impact exercises like walking, swimming, or yoga
  
• Consume a diet rich in anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids
  
• Manage stress through relaxation techniques, mindfulness, or counselling
  
• Pay attention to joint pain, stiffness, and other symptoms and seek medical evaluation if they persist or worsen
  
• Consult with a healthcare professional for regular check-ups and discuss any concerns related to joint health
  

FAQs