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Rheumatoid Arthritis of the Foot and Ankle

Rheumatoid arthritis or RA is a chronic inflammatory arthritis that can affect any joint in the body. It typically affects the small joints of the hands and feet in the early stages but may later progress to involve larger joints such as the shoulders, elbows, knees and hips. The cervical spine or neck area may be involved in later stages of the disease. Rheumatoid arthritis is symmetrical meaning the same corresponding joint on the other side of the body is also affected. The affected joints present with swelling, pain and stiffness resulting in limited motion. Nodules made of firm solid tissue may occur under the skin of the arms in severe cases. Other symptoms may include fatigue, fever and weight loss. If not treated early and aggressively rheumatoid arthritis results in joint deformity and disability.

RA can occur at any age but is more common in people between 40-60 years of age. Women are more likely to develop it than men. Smoking and a family history of rheumatoid arthritis increases the risk of developing the disease.

Although RA is not an inherited disease the presence of certain genes increases the susceptibility to environmental factors such as infection that can trigger onset of the disease. RA occurs when the immune system attacks the joints causing inflammation. The focus of inflammation is the synovium, the thin membrane that lines the joint and secretes lubricating substances. The inflammation causes hyperplasia or an increase in the number of cells of the synovium resulting in thickening of the joint lining causing warmth, redness, swelling and pain in the joint. As the disease progresses, abnormal synovial cells invade and damage the cartilage and bone within the joint.

Even the tendons and ligaments that hold the joint will weaken and stretch. Over a period of time the joint loses its shape and alignment causing joint deformity. Damage to the cartilage and bone is fastest in the first few years of the disease. Therefore, early diagnosis is crucial to prevent functional loss in the joint.

Early signs and symptoms of the disease are very general and non-specific such as malaise, fatigue, weakness, muscle soreness, low grade fever and weight loss. Moreover, there is no single test or physical finding to confirm the disease. This makes early diagnosis of RA very challenging.

The diagnosis of rheumatoid arthritis may include blood tests for Erythrocyte sedimentation rate, rheumatoid factor and anti-CCP antibodies. An elevated ESR indicates the presence of inflammation in the body. X-rays of the affected joint may be recommended to track the progression of the disease over a period of time.

There is no cure for Rheumatoid Arthritis but early aggressive treatment can delay joint destruction. Treatment is aimed at controlling symptoms and preventing joint damage by mainly reducing inflammation. Medications may include non-steroidal anti-inflammatory drugs or NSAID’s, steroids, disease modifying anti-rheumatic drugs, immune-suppressants, TNF-alpha inhibitors and other medications. Physical therapy is also recommended to keep the muscles strong and delay loss of function. Joint protection techniques, hot and cold treatments and splints or orthotic devices may also be recommended to reduce pain and improve joint movement.

If medications fail to prevent or slow joint damage, surgery such as total joint replacement, tendon repair or joint fusion may be considered to reduce pain and repair damaged joints.

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