What Is Rheumatoid Arthritis
Rheumatoid arthritis is a systemic disease that attacks multiple joints throughout the body. About 90% of people with RA eventually develop symptoms related to the foot or ankle. Usually symptoms appear in the toes and forefeet first, then in the middle and back of the foot, and finally in the ankles. Other inflammatory types of arthritis that affect the foot and ankle include gout, ankylosing spondylitis, psoriatic arthritis, and Reiter’s syndrome.
The exact cause of RA is unknown but there are several theories. Some people may be more likely to develop RA because of their genes. However, it usually takes a chemical or environmental trigger to activate the disease. In RA, the body’s immune system turns against itself. Instead of protecting the joints, the body produces substances that attack and inflame the joints.
Both Sides Of The Body Affected
Typically, the distribution of the joints involved in a person with rheumatoid arthritis is similar on both sides of the body. This symmetric joint involvement is a feature of classic rheumatoid arthritis. This does not mean that joint involvement is always symmetric, but it is common.
Rheumatoid arthritis usually involves many joints on both sides of the body. It is, therefore, sometimes referred to as an asymmetric polyarticular form of arthritis. Accordingly, the small joints of the hands, wrists, and feet are commonly affected. The knees, ankles, shoulders, hips, and elbows can also be involved in early disease. Rheumatoid arthritis is characterized by inflammation in these joints. Early manifestations of this inflammation can be gradual or rapidly intense. The joint inflammation causes stiffness, usually worse in the morning or after being sedentary. It also causes warmth, swelling, redness, and pain in varying degrees. The joint can be very subtly affected with slight swelling or markedly affected with substantial loss of range of motion. The pain level can be completely disabling and does not always correlate with the degree of apparent inflammation.
What Are The Early Signs Of Arthritis In The Legs
The early signs and symptoms of arthritis in the lower limbs may vary depending upon several factors such as
- The type of arthritis
- The extent of joint involvement
The early signs and symptoms of arthritis in the legs include
- Pain in the affected area
- Swelling at the affected site
- Stiffness in the affected joints, which may be worse in the morning
- The skin over the affected joint may appear red and inflamed
- Loss of function of the involved joint or muscle
- Loss of muscle mass at the affected site
- Presence of small, bony bump-like swellings
- The skin over the affected joint may be warm to the touch
- Psoriatic arthritis
- Deformities in the affected leg, ankle or foot
- A grating sensation inside the joint with movement
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Leg Ulceration In Rheumatoid Arthritis
14 June, 2001By NT Contributor
Patients with rheumatoid arthritis appear to be at increased risk of developing leg ulcers. The aetiology is not fully understood but it is likely that most are multifactorial in origin . The mean duration of open ulceration in people with RA is five to 15 months. This compares with six months in people with leg ulceration secondary to venous insufficiency, indicating that people with RA are more resistant to treatment . Leg ulceration in this group is also associated with significant morbidity.
VOL: 97, ISSUE: 24, PAGE NO: 63
Michele Grange, RGN, DipMW, is specialist clinical practitioner, rheumatology
Charles Henderson, RGN, is a staff nurse, Royal National Hospital for Rheumatic Diseases NHS Trust, Bath
The multifactorial nature of leg ulceration in people with RA necessitates a multidisciplinary approach to care to ensure a full assessment of the patients needs.
The lack of evidence in support of products or approaches specifically for the management of leg ulcers in people with RA means that close liaison between team members is invaluable in ensuring that all treatment options are fully explored.
Mrs Smiths RA had proved difficult to control and she presented with abnormal blood results indicating RA flare, immobility and joint stiffness, anaemia and swollen and inflamed joints. She was also malnourished.
In this instance multidisciplinary support and education have so far prevented Mrs Smith returning with the same problem.
Rheumatoid Arthritis Support Groups And Counseling
Living with the effects of rheumatoid arthritis can be difficult. Sometimes people can feel frustrated, perhaps even angry or resentful. Sometimes it helps to have someone to talk to.
This is the purpose of support groups. Support groups consist of people in the same situation. They come together to help each other and to help themselves. Support groups provide reassurance, motivation, and inspiration. They can help people see that their situation is not unique, and that gives them power. They also provide practical tips on coping with the disease.
Support groups meet in person, on the telephone, or on the Internet. Ask a health-care professional or contact the following organizations or look on the Internet to find a suitable support group. If someone does not have access to the Internet, go to the public library.
- Arthritis Foundation
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Inflammatory Arthritis Vs Osteoarthritis
Its important to realize the differences between these two types of arthritis. Osteoarthritis – which many people commonly refer to simply as arthritis – is a condition in which breakdown of the cartilage occurs in one or more joints resulting in pain as well as some stiffness and inflammation, but this does not occur as a result of the bodys altered immune response. While the cause of all osteoarthritis is not completely understood, it is generally associated with aging, “wear and tear”, or in some cases with traumatic injury to the joint. Unlike inflammatory arthritis, osteoarthritis is limited to the joints including small joints in the spine. However, the limited mobility that is a consequence of osteoarthritis can have an impact on ones general health. For instance if osteoarthritis affects the knees, and one cannot move about as easily, weight gain may occur, which in turn could impact risks for high blood pressure or diabetes.
What Are Causes And Risk Factors Of Rheumatoid Arthritis
The cause of rheumatoid arthritis is not known. Many risk factors are involved in the abnormal activity of the immune system that characterizes rheumatoid arthritis. These risk factors include
- genetics ,
- hormones , and
- possibly infection by a bacterium or virus.
Other environmental factors known to increase the risk for developing rheumatoid arthritis include
- silica exposure, and
- periodontal disease.
Medical scientists have shown that alterations in the microbiome exist in people with rheumatoid arthritis. Emerging research shows that the microbiome has an enormous influence on our health, immune system, and many diseases, even those previously not directly linked to the gastrointestinal tract. Studies have shown different kinds of bacteria in the intestines of people with rheumatoid arthritis than in those who do not have rheumatoid arthritis. However, it remains unknown how this information can be used to treat rheumatoid arthritis. Treatment is probably not as simple as replacing missing bacteria, but this may explain why some individuals with rheumatoid arthritis feel better with various dietary modifications.
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Types Of Inflammatory Arthritis
In order to make an accurate diagnosis, rheumatologists rely on a persons history of his or her joint and other symptoms, a physical examination, blood tests and, where needed, imaging techniques. Imaging can include X-Rays, ultrasounds of joints or MRI exams if a better understanding of a patients disease is required. If damage is already seen in the joints, this indicates that the type of inflammatory arthritis that is present may be more aggressive with a higher risk for more damage. There are many types of inflammatory arthritis. However, the following conditions are the most common:
: the most common form of inflammatory arthritis, tends to involve the small joints in the hands and feet and most often more than one joint is affected. The focus of inflammation is in the synovium , which can become swollen, warm, painful, and stiff, and eventually becomes damaged when inflammation is prolonged. In 30-60% of patients with RA, blood tests such as rheumatoid factor or anti-cyclic citrullinated peptide antibodies are positive, helping to confirm the diagnosis. RA can be a very destructive and disfiguring form of arthritis. It is important to control the inflammation in the synovium to stop joint destruction. In RA, other organs and systems in the body may also be affected, including the heart, lungs and eyes.
What Is A Rheumatologist
Rheumatologists are expert physicians who specialize in diagnosing and treating inflammatory arthritis and autoimmune diseases where joints can be involved. They also care for people with other diseases of the connective tissue and those with osteoporosis. As needed, the rheumatologist coordinates the care his or her patients receive from surgeons and other specialists, as well as from other health care professionals.
In many, but not all cases, people become aware that they have inflammatory arthritis when they develop symptoms of inflammation in one or more joints. On a simple level, joints are where two bones are attached. A joint can be fibrous and a simple connection without movement, such as joints in the pelvis. However, most joints are “ball and socket joints”, which are covered with a smooth layer of specialized tissue called cartilage – allowing for a gliding motion examples are the knees, elbows, shoulders, hips or elbows. Other structures that attach the bones to each other and to muscles include the tendons, tissue that attaches muscles to bones and the ligaments, tissues that attach bone to bone. These can also be targets of inflammation in inflammatory arthritis. Furthermore, the joints are held together by a capsule, a kind of protective container that is lined with a membrane called the synovium. In inflammatory arthritis inflammation of the synovium is what usually causes pain, stiffness and swelling. This is called “synovitis”.
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What Does It Feel Like
The numbness and tingling that develop with RA can occur in different areas of the body.
If the pain occurs in the wrist, a person might feel tingling and numbness in their hand and fingers. They may also feel pain. People with advanced RA may also experience a burning sensation.
People who have nerve damage may also experience the following sensations:
- pins and needles
Manage The Rheumatic Disease Manage The Foot Pain
Surgery is often needed to alleviate the pain associated with bunions, hammertoes, and nodules, according to AAOS. Foot surgery may involve resetting the bones or fusing joints to correct the position of bones and joints.
Local steroid injections are particularly beneficial for inflamed joints and plantar fasciitis. But before you schedule surgery or an office visit for injections, you might try non-invasive approaches such as braces, or choose shoes or inserts designed to support your feet, AAOS recommends.
Uncontrolled inflammation leads to joint bone erosions and other damage, which leads to foot deformities, said Lightfoot. Early use of the newer and much more effective remittive drugs to lesson or eliminate inflammation is key to preventing bone damage and resulting deformities, Lightfoot says.
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What Are The Less Common Forms Of Rheumatoid Arthritis
Rheumatoid arthritis can begin in less common forms. For example, it can begin with the involvement of only a single joint or a few joints. Sometimes, this can later evolve to the more common presentation of many joints on both sides of the body.
Rarely, the earliest symptom of rheumatoid disease is inflammation of a body area that does not even involve a joint. For example, the lining of the lungs can become inflamed to cause pleurisy many months before arthritis develops.
Occasionally, only a few joints are involved and the doctor may suspect another type of inflammatory arthritis. Again, this can sometimes only later evolve to become the more typical symmetrical polyarthritis by including many joints on both sides of the body.
The caveat is that by recognizing the early symptoms of rheumatoid arthritis rheumatologists and their patients can address the disease early, thereby affording optimal outcomes for those affected.
You Might Be Aware Of Joint Pain But Its Important To Be Aware Of The Other Ra Symptoms That Can Help Clinch A Diagnosis
Aches and pains are a common part of life at every age, and can occur for many reasons an especially tough workout, too much snow shoveling, lifting something the wrong way, dancing too enthusiastically, or engaging in repetitive hand motions like typing or knitting.
But pain is also the most common symptom of rheumatoid arthritis , a chronic, inflammatory disorder in which the bodys own immune system attacks the lining of the membranes that surround the joints. According to the American College of Rheumatology, RA is the most common type of autoimmune arthritis, affecting more than 1.3 million Americans 75 percent of whom are women. The disease usually strikes first between the ages of 30 and 60.
The symptoms of RA may be obvious or not, and can sometimes mimic other diseases, especially in the early stages. The most common symptoms of RA such as pain, swelling, and tenderness around the joints tend to come on gradually. People may discount minor pains or morning achiness as just a sign of aging or indication of an overuse injury. It may take a while before someone suspects that RA is the cause of their discomfort. But rheumatoid arthritis has many other symptoms as well, and recognizing what they are can help patients get diagnosed and treated as early as possible, so they can prevent or minimize permanent damage to the joints, and lead active, less-painful lives.
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Symmetry Of Pain In The Legs
Rheumatoid arthritis usually flares up in several joints of the legs symmetrically . Early symptoms can be almost invisible. The small joints of the hands and especially the wrists are often attached to this process. People suffering from rheumatoid arthritis can not perform even the simplest tasks of everyday life, such as turning the door handle and opening the can. Small foot joints are also often involved in the pain process, it can lead to painful walking, especially in the mornings, when a person has just got out of bed. Sometimes only one joint becomes inflamed.
When only one joint is involved in the pain process, inflammation of the joints, caused by other forms, such as gout or joint infections, may occur. Chronic inflammation can lead to damage to body tissues, including cartilage and leg bones. This leads to loss of cartilage, erosion and weakness of bones, as well as muscles, which leads to joint deformation, destruction and loss of leg and hand function.
Rarely, rheumatoid arthritis is able to greatly affect the joint, which is responsible for tightening our vocal cords to change the tone of the voice. When the joint becomes inflamed, it can lead to hoarseness of the voice. Symptoms in children with rheumatoid arthritis include limping, irritability, frequent crying and poor appetite.
Chronic Joint Pain In The Knees Elbows Hips And Shoulders
Some RA patients may also experience inflammation in the joints of the knees, elbows, and hips. One or both shoulders might also become swollen, lessening range of motion so lifting or reaching becomes painful.
Rheumatoid arthritis typically does not affect the lower back, though a person may experience back pain if they are having difficulty moving other joints or walking, says Manno.
In a small percentage of people, the joint swelling can come and go, sometimes moving around to different joints and even disappearing for a time, a condition known as palindromic rheumatism. But in the vast majority of people, the joint swelling persists and worsens until its treated with medication. With treatment, the majority of people can achieve a significant lessening of symptoms or possibly even remission.
What Are The Symptoms Of Rheumatoid Vasculitis
When vasculitis involves the small arteries and veins that nourish the skin of the fingertips and skin around the nails, small pits in the fingertips or small sores causing pain and redness around the nails can occur. Involvement of somewhat larger arteries and veins of the skin can cause a painful red rash that often involves the legs. If the skin is very inflamed, ulcers can occur and infection becomes a complicating risk.
Vasculitis that injures the nerves can cause loss of sensation, numbness and tingling, or potentially weakness or loss of function of the hands and/or feet. The rare vasculitis of larger arteries can cause complete absence of blood flow to tissue sites supplied by the affected vessel , which can cause gangrene of fingers or toes, stomach pain, cough, chest pain, heart attack, and/or a stroke if the brain is involved. This form of systemic vasculitis can also be accompanied by general symptoms such as fever, loss of appetite, weight loss, and loss of energy.
Skin Issues With Ra In The Feet
Changes in your foot shape can result in pressure spreading out unevenly across your foot as you walk. Excess pressure can result in skin conditions:
- Bunions are thick, bony bumps that develop in the joint at the base of your big toe or fifth toe.
- Corns are thick, hardened skin patches that may be larger and less sensitive than the rest of your foot skin.
If theyre not treated, both bunions and corns can develop into ulcers. These are open sores that result from skin breaking down due to a lack of circulation or tissue damage in the foot. Ulcers can become infected and cause further foot pain and damage.
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