Rheumatoid arthritis (RA) is a chronic autoimmune disease that attacks multiple joints throughout the body. This means that the immune system attacks its own body tissues. The defenses that usually protect the body from infection instead damage normal tissues (such as cartilage and ligaments) and softens bone. It most often starts in the small joints of the hands and feet, and affects the same joints on both sides of the body.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to blood vessels, nerves, and tendons as well.

All the joints of the body are covered with a special lining -called synovium – that lubricates the joint and makes it move smoothly. Rheumatoid arthritis causes an overactivity of this lining causing it to swell and become inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities such as claw toe or hammer toe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone. All these changes also cause pain to the areas.

Statistics

Rheumatoid arthritis affects approximately one percent of the population. Women are affected more often than men, with a ratio of up to three to one. Symptoms most commonly develop between the ages of 40 and 60. More than 90 percent of people with rheumatoid arthritis develop symptoms in the foot and ankle over the course of the disease. In about 20 percent of patients, foot and ankle symptoms are the first signs of the disease. Deformities of the hands and feet are the more obvious signs of RA.

Cause

The exact cause of RA is not known. There may be a genetic reason; some people may be more likely to develop the disease because of family heredity.

Symptoms

The most common symptoms are pain, swelling, stiffness, abnormal appearance of feet due to deformities and difficulty walking. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot. Foot problems caused by RA commonly occur in the forefoot (the ball of the foot, near the toes). Deformities and conditions associated with RA may include:

• Rheumatoid nodules (lumps), which cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking.

• Dislocated toe joints.

• Hammertoes.

• Bunions.

• Heel pain.

• Achilles tendon pain.

• Flatfoot ankle pain.

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