How is a Rheumatoid arthritis treated?
Treatment aims to reduce symptoms and slow the disease progression. This involves preserving the joint function, relieving pain, controlling the systemic involvement and protecting the joint’s internal surfaces.
The treatment generally involves medication from the GP, orthopaedic surgery as necessary and podiatry. A variety of allied health professionals such as physiotherapy and occupational therapy also have a role to play.
Podiatrists play a pivotal role in management of rheumatoid arthritis. This is because weightbearing significantly worsens the impacts of the condition on the feet and lower limbs.
Podiatrists provide:
- Skin and nail treatment
- Digital accommodation for deformities
- Orthoses to support the natural foot function / alignment.
- Advice on appropriate footwear
- Physical therapies and soft tissue mobilization
- Bracing as necessary.
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic, inflammatory autoimmune disease characterized by progressive joint destruction and disability.
Symptoms:
People with Rheumatoid arthritis have joint stiffness in the morning. This usually exceeds 60 minutes and affects >3 joints.
Rheumatoid arthritis causes pain, oedema (swelling), stiffness, weakness and deformity of the joints. It affects either the hand or foot and progresses towards the body.
Difference with osteoarthritis:
It is different from common osteo-arthritis in that the stiffness often lasts longer. Furthermore, There is also redness and warmth of the affected joints.
Another important difference between the two is that rheumatoid arthritis has associated systemic symptoms. These include fatigue, malaise (feeling unwell), anorexia and fever.
How is it diagnosed?
The diagnosis of rheumatoid arthritis is made on a combination of symptoms with X-ray’s. The X-ray’s will show different things at different stages of the disease process.
Early stage X-rays:
At the early stage it shows soft tissue swelling, the breakdown of the bones surrounding joints and inflammation of the joint spaces themselves (synovitis).
Mid-stage X-rays:
As the disease progresses the joints begin to lose the space between them. Thereafter, little bony erosions form near to the joints called “rat-bite” erosions.
Final Stage X-rays:
In the final stages of the disease there will be an increase in the bony erosions. There will also be a weakening of the structure of the bones (osteopenia), joint subluxations (coming out of place), inflammation of the areas around the joints. Furthermore, there will be little areas inside the bones near joints where it appears the bone has disintegrated. These are called pseudocysts.
With the X-rays, in conjunction with a blood test to confirm a certain chemical called rheumatoid factor, the previously mentioned symptoms and how the condition looks in clinic, for example are there nodules forming on the affected joints – the doctor will make a diagnosis.
