RHEUMATOID arthritis (Rh/A) is a chronic autoimmune disease where the immune system that ususally fights infection attacks the cells that line the joints.

Bone, cartilage, tendons, and ligaments can all be affected. These areas become swollen, painful and stiff. It is not clear what triggers this problem, but it is thought to be linked to a virus or infection. However, this has not been proven. Rh/A is a disease that tends to start in the small joints of the hands and feet.

The feet are affected in 90 per cent of cases. As it causes damage to the joints, tendons, and ligaments, foot deformities tend to occur, such as claw toes, hammer toes and bunions. In some cases, the bones soften (osteopenia), resulting in stress fractures.

RISK FACTORS

There are a few things that can increase your risk of developing the disease.

1. There is some evidence that it has a genetic link and so can run in families.

2. Women are more likely to have the disease than men, due to the higher oestrogen levels.

3.Smokers have an increased risk.

WHO IS AFFECTED?

Rh/A can occur at any age, but is most common in women between the ages of 40 and 50. It has been suggested that three times as many women have the disease than men.

WHAT ARE THE SYMPTOMS?

The most common symptoms are swelling, stiffness and pain. They usually appear on the same joints on both feet. As the disease progresses, patients find it difficult to walk on uneven surfaces, inclines and stairs.

The bones move out of their normal alignment ,causing flat-foot deformity. Under the ball of the foot, painful lumps may occur as the toes become fixed in a clawed position.

These bumps often develop thick calluses which can be very painful and, if left untreated, may lead to ulceration.

HOW IS IT DIAGNOSED?

This can be a difficult condition to diagnose, especially in the early stages, as it often mimics other diseases. Blood tests can be carried out, including one that will look for an increase in rheumatoid factor.

Physical examinations will check for joint swelling, heat, muscle strength, and reflexes. Magnetic resonance imaging (MRI) scans and X-rays may help track the progress of the disease.

TREATMENT

There is no cure for Rh/A so the aim is to manage the symptoms. Treatment depends on the extent of the damage and pain.

1. Supportive, shock absorbing and wellfitted shoes are fundamental to pain relief. Patients with extensive joint destruction should get specialist footwear that can accommodate their feet comfortably.

2. Braces can provide good support to the foot and ankle. These are usually bespoke and made by specialists.

3. Orthotics and insoles can be manufactured to reduce the pressure from prominent bony areas. This should reduce pain and callus formation.

4. Icing a painful part of the foot will reduce inflammation and is very effective. This can be carried out four times a day with ice wrapped in a towel and held to the affected area for approximately 10 minutes.

5. Exercises like cycling, swimming or using elliptical training machines allow patients to maintain their health without placing a large impact on the foot.

6. Non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed as these reduce pain and inflammation.

7. Steroid injections and tablets may also be prescribed.

8. Other medications are also available, such as diseasemodifying anti-rheumatic drugs (DMARDs). This can be discussed with your doctor or rheumatologist.

9. Surgical intervention is sometimes indicated, depending on the joint damage and the patient’s response to non-surgical options. Joint fusions are the most common type of procedure carried out.

NATURAL REMEDIES?

Magnetic therapies, which come in the form of rings, bracelets and necklaces, have been thought to be helpful with Rh/A, but research suggests they are more helpful with osteoarthritis. Acupuncture studies show that it may also be helpful.

Examples of foods known to reduce inflammation are oily fish, turmeric and extra virgin olive oil. Some people find that certain foods are triggers for flare-ups of the condition, so monitor your diet carefully and eliminate those foods.

Before any treatment is undertaken, you should consult with your general practitioner, rheumatologist and podiatrist.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293- 7119), Mandeville (962-2100), Ocho Rios (974- 6339), Kingston (978-8392), and Savanna-la- Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.