Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic immune mediated inflammatory disease of unknown etiology. It is the second most common form of chronic arthritis after osteoarthritis.

Rheumatoid arthritis is characterized by an uncontrolled proliferation of synovial cells which causes erosion of the surrounding bone, leading to joint damage. Damage to the tendons and ligaments can also occur, which can lead to muscle atrophy from underuse. The result is chronic pain, joint dysfunction and disability.

• Low grade fever
• Anemia
• Rheumatoid arthritis is characterized by flares of disease followed by disease inactivity
• Multiple joint pain, regardless of overuse.
• Rheumatoid arthritis in the foot can be seen as enlarged joints. There can be metatarsal pain, widened forefoot, hallux valgus, and severe flat foot.

• Strong genetic component around 60%
• Peak incidence around 55-64 for women and 65-75 for men
• Smoking can increase severity if you have RA, though does not increase incidence of having RA

• No cure for RA presently
• Management tries to minimize stiffness and swelling, maintain mobility
• Management involves accommodation of deformity to prevent further deformity. – accommodation of width, length and toe box depth. Sometimes a custom-made shoe may be necessary
• Orthotic management is almost always needed as enlarged nodules in the foot can be very uncomfortable and painful with weightbearing. Foot deformity make over the counter insoles less effective.
• Regular chiropody care is recommended to care for nails, callus and offloading. Special care is taken due to thinning skin, higher risk of infection, and poor blood supply.
• Physical therapy – to improve movements and maintain muscle strength.
• Medications involved can include anti-inflammatories, and anti-rheumatic drugs.

It is thought that RA can start as a strong immune response to trauma or infection, though currently, there is no known etiology of rheumatoid arthritis.