Rheumatoid Arthritis

Top of two feet with bunched up toes showing the physical signs and symptoms of rheumatoid arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis is a long term autoimmune disorder that affects your body through persistent damage to the lining of the joints. Unlike the wear-and-tear damage of osteoarthritis, this mostly occurs through no fault of your own. It occurs when the immune system doesn't work properly, by mistakenly attacking your own healthy cells. 

One of the distinguishing factors of the disease is that it affects the joints on both the left and right side of your body and across multiple joints. Compared to osteoarthritis, which is commonly unilateral and isolated to minimal joints. 

The joints commonly involved 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 & risk factors

For most people, your immune system helps to defend your body against infection. With rheumatoid arthritis, your immune system malfunctions and mistakes your body's cells for invaders. This results in the releasing of inflammatory chemicals that attack the synovium. The synovium is the soft tissue that lines the joints and produces a fluid that helps the joint move smoothly. When the synovium becomes inflamed, it thickens, causing the area to feel painful and tender, look red and swollen and it can even minimise movement around the joints.

Over time, this eventually destroys the cartilage and bone within the joint. Thus the tendons and ligaments holding your joint together will weaken and stretch, causing the joint to lose its shape and alignment. 

It's not currently known why your immune system decides to attack your body instead of the intruders. Researchers believe it could be connected to your genetic build, meaning that certain genes, when activated by an environmental trigger, such as a virus or bacteria, triggers the disease. 

There are certain factors that may increase your risk of developing rheumatoid arthritis, including:

  • Age. It can affect people of any age but is more common in people over 50.
  • Biological sex. 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're more likely to have the disease. 
  • 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.

Symptoms

Symptoms of rheumatoid arthritis are individual and can affect people in many ways. In the early days of the disease, you may not see large amounts of swelling or redness, however you are likely to experience pain and tenderness. 

Symptoms that may alert you to the presence of rheumatoid arthritis 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
  • Muscle and joint pain with fatigue, fever and loss of appetite 

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 diagnose as the early symptoms mimic those of many other conditions and diseases. Due to this, and the fact that the disease gradually worsens over time, it's important to get an accurate diagnosis early to ensure treatment can be started early and any lifestyle changes can be made.

To diagnose rheumatoid arthritis, the podiatrist would complete a 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 they suspect rheumatoid arthritis, they will refer you to a GP to get blood tests done. These look for inflammation and the presence of specific blood proteins. The tests a GP may administer include:

Our podiatrists may also request an X-ray, ultrasound or MRI to reveal any joint damage 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. 

Treatment

Unfortunately, there are currently no permanent cures for rheumatoid arthritis, but if detected early, the symptoms can be managed and reduced. 

Our podiatrists may recommend a combination of the following treatments:

  • GP/specialist referred medications
  • Modified exercises to maintain strength and flexibility
  • Switching to shoes with more cushioning and support
  • Using custom prescribed orthotics to offload joints/bones that have been affected by damage

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 getting the disease: 

  • If you are a smoker, stop smoking. There is a strong relationship between smoking and rheumatoid arthritis, so it's very important to quite smoking.
  • Maintain a healthy weight.
  • Avoid exposure to environmental pollutants such as asbestos and/or silica. 

FAQs

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