Arthritis and Joint Pain

ARTHRITIS AND JOINT PAIN

Many people visit their physicians with compliant of foot pain that they contribute to arthritis. Many people think that as they age arthritis is “normal” and that it is okay to be suffering with this pain. The truth is there are many different types of arthritis that affect the foot and ankle, and people don’t have to suffer with pain sine there are many different treatment options.

OSTEOARTHRITIS

The most common type of arthritis to affect the foot and ankles is osteoarthritis. Osteoarthritis affects over 50 million Americans and as the population ages the numbers will continue to rise. Osteoarthritis is a degenerative process where the cartilage in the joints becomes eroded. This may lead to pain, stiffness, swollen joints, hearing cracks in the joints while walking, feeling like joints “are about to give out” and decreased in daily activities of life. This type of arthritis is related to an increase in age, trauma, genetics, and other medical conditions. Diagnosis is made by clinical exam and/or by x-rays, MRI, and CT.

What type of treatment options are there for me?

Osteoarthritis in the foot and ankle is usually treated with conservative measures first. Decreasing one’s weight and increasing one’s activity may reduce the symptoms of osteoarthritis. Exercise, which is not destructive on the joints, is good to help with the pain, such as swimming. Anti-inflammatory medications help with pain reduction but are not always a long term solution. There are different types of anti-inflammatory medications depending on the severity of the osteoarthritis. Some of the anti-inflammatory medications have gastrointestinal side effects. In addition, there are topical anti-inflammatory medications, which have no systemic gastrointestinal effects. Injections of steroids into the affected joints, will help with short term pain reduction, but will not help with cartilage loss.

If all of these measures fail, surgery is the next step in treatment. Depending on where the osteoarthritis is located and what the exact symptoms are, will determine what type of surgery is required. If the ankle is affected, arthroscopic surgery is performed as first line therapy. If that does not help an ankle fusion or replacement may be required. There are many other foot joint, such as the subtler joint, that can be affected by arthritis. If this is the case fusion of that joint is necessary. Prior to surgery your physician will order an MRI or CT to determine the extent of the arthritis and the cartilage loss. The recovery from these surgeries is a few months in a cast with no weight to the leg. Due to the extent of the surgery and the recovery, this option is a last resort for the really debilitating cases of arthritis.

Osteoarthritis is the most common type of arthritis to affect the foot and ankle, in next week’s blog other forms of arthritis, such as rheumatic and psoriatic, will be discussed.

RHEUMATOID ARTHRITIS

Rheumatoid arthritis, also known as RA, is an autoimmune disease that affects synovial joints. It is a painful disease and without treatment it can cause severe disability. 85% of people with RA have symptoms in their ankle and foot joints. Joints with RA appear to be swollen, painful, warm and may become fused over time.  Below is a picture of RA in the hands, which causes severe swelling in the joints.

RA is different from osteoarthritis in that classic RA there appears to be stiff joints in the morning, whereas with osteoarthritis there are stiff joints throughout the entire day. With Osteoarthritis it gets worse over time and then becomes stable, RA becomes worse over time to a point where one cannot function or do daily life tasks.

Diagnosis is made with a multitude of test and via clinical exam. An x-ray of the feet during the mid to late stages of the disease may show subluxed/dislocation joints. In addition, there is decreased space within the joint and an increase in swelling around the joint. A blood test to test for Rheumatoid Factor can be performed, but a positive test doesn’t always mean there is RA and vica versa. During the course of diagnosis it is crucial to see a Rheumatologist, who can help rule out other autoimmune and rheumatologic diseases.

Treatment involves prolonging the disability that comes with the disease. Anti-inflammatory medications as well as disease-modifying antirheumatic drugs (DMAIRs) drugs are the mainstay of treatment. A Rheumatologist will prescribe and monitor these medications. Exercise is also important to help to decrease the symptoms and the disability of the disease.

RA in the foot causes lateral subluxation of the toes, this means that the toes tend to drift to the outside of the foot. Below is a picture where this can be seen.

This foot deformity can be prevented as the physician begins to see the toes are drifting. Once the deformity has occurred the best way to treat this is via surgery. The surgery will re align the joints that are causing the foot to deform. A foot like this can cause a great amount of pain, callus build up and can be very difficult for someone to find shoes.

In conclusion, rheumatoid arthritis is a systemic autoimmune disease that can affect all systems of the body and all aspects of one’s life. Early diagnosis is crucial to prevent long term problems. Concomitant care by your physician and by a rheumatologic specialist is critical for proper early treatment.

PSORIATIC ARTHRITIS PA is more common between the ages of 30-50 and it affects men and women equally. Like some of the other arthritic diseases we discussed in the past few blogs, people with PA can present with an array of symptoms. Systemically, patients can present to the physician being fatigue and lethargic.  Common symptoms are red, hot, painful and swollen joints. PA tends to affect the feet and ankles more than most other joints in the body. Patients can present with large red toes, also known as sausage toes. Pain in the Achilles tendon and/or plantar fascia is a common symptom in this disease. Other common symptoms would be discoloration and separation of the toenails. In addition to have these symptoms a patient would have to be diagnosed with the psoriatic skin disorder to be diagnosed with PA. There is a genetic component to the disease, but there is little that is known about the exact cause.

How do I get diagnosed with RA?

Just like some of the other rheumatologic disease, a Rheumatologist should be consulted to confirm or deny the diagnosis. There are no specific tests to diagnose a patient with RA, but other diseases can be ruled out.  A telltale sign to differentiate this disease from RA would be it affects the distal knuckles in the toes and fingers.  X-rays, MRI, CT scan or Ultrasounds can be performed to assess which joints are affected and the severity of the disease.  

How do I get treated for RA?

Just like the other rheumatic diseases, anti-inflammatory medications and the disease modifying antirheumatic agents are the common ways to treat it. Locally, corticosteroid injections into the affect joints can be performed as well. Exercise is important so that joints do not get stiff and cause long term disability.

This concludes the series of arthritis and the lower extremity. In conclusion, there is a lot of overlap with the symptoms and diagnosis of arthritis in the lower extremity. You should not ignore symptoms and should see a physician as soon as possible.