Rheumatoid Arthritis

Rheumatoid arthritis (“RA”) is an auto-immune disease that causes chronic joint inflammation. It is a chronic, progressive disease that can also affect other organs in the body.  It is characterized by periodic flare-ups of joint pain, stiffness and swelling that can eventually make movement difficult.  The small joints in the feet are among those most commonly affected.  

Rheumatoid arthritis attacks joint tissue, which leads to buildup of inflammation and calcification.  This buildup restricts proper joint movement and makes them stiff.  Joints need to move to stay healthy; when they can’t, it triggers a vicious cycle:  The lack of movement makes the stiffness, inflammation and calcification worse, leading to muscle weakness from underuse.  The joints and muscles then become more injury prone, which triggers more inflammation and calcification. This cycle of inflammation and calcification buildup ultimately leads to chronic pain, joint dysfunction and disability.  

Fortunately, there are many effective treatment options available that can help disrupt this cycle:  The chiropodists and foot specialists at our clinic provide many services that can help you manage the disease, halt its progression, reduce symptoms and improve function in your feet and ankle joints.

There are many different types of rheumatoid arthritis with a constellation of symptoms.  It is a systemic disease, meaning that it affects many organs in the body – not just the joints.  The most common signs and symptoms of rheumatoid arthritis specifically in the feet are:

• “Flare-ups” of muscle and joint pain and stiffness.  This pain is usually described as a dull ache or soreness (like a bad toothache), but it may at times be sharper. The flare-ups may come and go, or be persistent. 
• Increased joint and muscle stiffness in the early morning (often referred to as “morning stiffness”).  
• Swelling and sensation of warmth in the affected joints
• Enlarged or swollen joints in the ankle, feet and toes.
• Unexplained pain or difficulty with activities involving the feet (i.e.: walking, standing, running, stairs)
• A combination of foot deformities, such as bunions, claw toe, hammertoe, bumps on the balls of the feet, bony bumps around the joints, widened forefoot (splay foot) and severe flatfoot
• Loss of range of motion in the ankles and toes. 

Other non-joint related signs and symptoms are:

• Low grade fever
• Anemia
• Fatigue

Usually Rheumatoid Arthritis affects the same joints on both sides of the body.  However, both sides may not necessarily flare up at the same time, or to the same extent (i.e.: one side may be worse than the other). 

Symptoms usually progress gradually and become increasingly painful over time.  Onset is usually around middle-age (i.e.: between 45 and 65); however some people may get symptoms earlier.  It affects more women than men. 

Rheumatoid Arthritis is an auto-immune disease, meaning that it is caused by an overactive immune system.  The immune system is designed to protect our body from harmful invaders; however, when it has an auto-immune disorder, it gets “overprotective” and attacks healthy cells too. In the case of Rheumatoid Arthritis, the attacked cells are the synovium, a layer of tissue that surrounds our joints and helps them move.  When the synovium is attacked, the immune system tries to protect and heal the joints by producing inflammation and calcification (hard mineral deposits).  

This is normally the way a healthy immune system heals joint and muscle injuries.  However, with Rheumatoid Arthritis, the immune system gets confused and keeps building inflammation and calcification when it doesn’t need to. Unfortunately, this buildup produces swelling, restricts the joint’s movement, and triggers pain.  Over time, healthy tissue and bone erodes.  This leads to joint deformities and damages the surrounding ligaments, tendons and muscles.  

The definitive underlying causes of Rheumatoid Arthritis are complicated and not known with certainty.  It is believed to be caused by a delicate interplay of genetic and environmental factors.  Genetics appear to play a role in 40 – 50% of cases, but there appear to also be environmental factors that may trigger it in a genetically predisposed person.  

Some of these environmental factors are:

• Inactivity
• Obesity
• Trauma or injury  
• Biomechanical or musculoskeletal deformities
• Gum disease (periodontal disease):  The inflammation buildup in the gums can trigger an inflammatory response in the joints. 
• Smoking: Tobacco smoke puts stress on the body that stimulates an auto-immune response, which in turn triggers inflammation.
• Heavy alcohol consumption
• Hormones: There is research to suggest that decreased hormone levels in women may contribute to the disease.

Triggers that may cause “flare-ups” of the disease are:

• Over-exertion of affected joints and muscles.
• Weight gain
• Weather
• Trauma
• Consumption of foods that trigger inflammatory processes (check out this great article from Harvard Health for more information)
• Heavy alcohol consumption
• Smoking
• Hormonal fluctuations in women

Although there is no cure for Rheumatoid Arthritis, it can be successfully managed with proactive and diligent treatment.  There have been substantial developments over the years that halt the disease’s progression, reduce pain, improve function and even reverse some of the muscle and tissue damage.  

Treating Rheumatoid Arthritis in the feet and ankles hinges on overall health and well-being.  This requires a comprehensive approach that integrates a combination of the following (note: These treatments are specific to rheumatoid arthritis in the feet and ankles):

Active Rehabilitation and Exercise:  

Regular exercise involving strengthening and conditioning the affected muscles is the pillar to long-term successful management of Rheumatoid Arthritis. It helps you regain muscle strength, rebuild your range of motion, and potentially even reverse the damage caused by chronic inflammation.  Medical studies conclusively show that patients who incorporate active therapy into their routine show the best long-term outcomes and improvement.

Don’t worry: this does not mean you have to spend hours at a gym.   A foot specialist can recommend healthy, safe movement exercises specially catered toward your unique medical needs.  These exercises are super quick and don’t involve much exertion: You can even do some of them while lying in bed or watching television on your couch.  You can try some of the ones here.

Naturally, it can be difficult to be physically active when you can’t even move in the first place.  That is why active therapy is often prescribed in conjunction with other treatments (below):  the objective is to use these treatments to alleviate your symptoms enough so that you can then do the exercises.  

Ergonomic Aids from a Foot Specialist: 

A chiropodist can help you find adaptive equipment and technology to accommodate any resulting deformities (i.e.: claw foot, hammertoe, joint swelling, etc.).  These will also encourage healthy biomechanical movement, which in turn reduces strain on our feet and ankles.  This includes:

• Proper Footwear:  Our clinic carries a variety of specialized shoes that specifically accommodate the effects of RA and support the joints. Our foot specialists can also get you custom shoes specifically engineered for your feet and body mechanics.
• Custom Orthotics:  Over-the-counter insoles typically are less effective for any foot deformities resulting from rheumatoid arthritis. Orthotics, on the other hand, can easily accommodate these deformities while letting you keep your existing shoes.  They can be customized to each foot.   
• Regular Chiropody Care:  Proper foot care is important for managing the effects and progression of Rheumatoid Arthritis in the feet, but this can be difficult when you have arthritic pain.  Fortunately, a chiropodist can carefully do the maintenance for you. A chiropodist can also specially care for thinning skin, areas of high risk of infection and poor blood supply – things that can’t be properly tended to when you get a pedicure at the salon.

Medication:  

• Anti-inflammatory medication:  As the name suggests, these medications reduce inflammation, which reduces stiffness and allows the joints to move easier.  Examples are: Aspirin, Ibuprofen and Naproxen and Corticosteroids.

• Anti-Rheumatic medication:  These medications are designed to suppress the immune system targets the underlying mechanisms behind the auto-immune response that causes the disease. 

These are just some of the ways you can treat Rheumatoid Arthritis in your feet and ankles.  For further information, check out these great resources from arthritis.org!

Although the exact etiology of Rheumatoid Arthritis is unknown, there is compelling evidence that the following risk factors play a role:

• Genetics: There are many genes that may cause Rheumatoid Arthritis.  Our genetic makeup can also make us more sensitive to environmental factors or joint and auto-immune disorders.
• Inactivity
• Obesity
• Trauma or injury
• Biomechanical or musculoskeletal deformities.
• Gum disease (periodontal disease):  The inflammation buildup in the gums can trigger an inflammatory response in the joints. 
• Smoking:  Tobacco smoke puts stress on the body that stimulates an auto-immune response, which in turn triggers inflammation.
• Heavy alcohol consumption:  Although mild to moderate alcohol consumption may in fact reduce some types of inflammation, too much will trigger it.

There is no definitive sure-proof way to prevent Rheumatoid Arthritis all together.  The genetic risk factors for developing rheumatoid arthritis are beyond our control.  However, we can do the following to control some of the environmental risk factors, slow or prevent the disease’s progression, and prevent/manage flare-ups and joint pain: 

• Stay active:  Physical activity and regular exercise is good for us anyway.  Focus on exercises that strengthen the muscles and encourage good biomechanics – like yoga. Movement prevents inflammation buildup, keeps our joints healthy and strengthens our muscles.  This makes our joints less susceptible to disease and trauma.
• Don’t smoke:  Smoking causes an inflammatory reaction in our body that has been linked to Rheumatoid Arthritis.
• Maintain a healthy weight: Excessive weight gain places extra strain and burden on our muscles and joints, which may trigger an auto-immune response.  
• Dental Hygiene: Poor dental hygiene can lead to gum disease, which inflames our gums.  This causes more than tooth pain: it can also confuse our immune system and cause inflammation in our joints.  So don’t forget to floss!
• Consume alcohol in moderation: It has been suggested that mild to moderate alcohol consumption reduces inflammation; however habitual heavy alcohol consumption increases inflammation.
• Maintain a healthy diet:  There are many foods that act as natural anti-inflammatories, like tomatoes.  There are also foods that raise inflammation.  You can read this great article from Harvard Health to learn more.  In any event, a balanced diet is good for us anyway: it helps us maintain a healthy weight and makes it easier to stay active.

In essence, the best way to prevent or offset the effects of rheumatoid arthritis is to maintain our overall health and well-being to the best of our abilities; the rest is beyond our control.  

Our foot clinic offers many solutions for managing and preventing the effects of arthritis-related joint pain.  To book an assessment with one of our foot specialists, use our online booking form or contact us at 416-769-FEET (3338) – no referral required.