Problems in the joints of the hands and feet are common symptoms of rheumatoid arthritis, and can be some of the first symptoms of the disease.
Rheumatoid arthritis is an inflammatory autoimmune response that attacks multiple tissues and organ systems throughout the body. One of the hallmarks of the disease is damage to the joints. The Arthritis Foundation says this occurs when inflammation attacks the synovium, the sheath lining the joints, causing it to swell and bulge.
The inflammatory process also weakens, stretches and even ruptures the tendons that connect the muscles to the bones in the joints, which can ultimately cause the joints to become displaced and disfigured.
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Joint involvement in RA is usually symmetrical — occurring on both sides of the body, although this is not always evident early in the disease.
Pain and tenderness in the hands often occurs in the middle joints of the fingers, or the joints at the base of the fingers. Tingling and numbness in the hands is also an early symptom of RA and is usually caused by swelling in the wrist joints that places pressure on the median nerve running through the carpal tunnel of the wrist.
In the feet, joints at the base of the toes may become tender, making it painful to walk and causing people to shift weight to the heels and bend the toes upward while standing or walking. The balls of the feet may also hurt, and in some individuals, the heel may also become painful. The tops of the feet may become red and swollen.
According to the American Orthpaedic Foot & Ankle Society, about 90 percent of people with RA will eventually develop problems with the feet.
However, the severe, often crippling deformities of the hands and feet and other joints that used to be a common consequence of RA may be going the way of the dinosaurs. The good news is that modern treatment medications and strategies for RA have slowed, and even prevented, severe joint damage to the hands, feet and other joints of the body.
“Disfigurement is much less common today than it was in prior decades,” according to Dr. John M. Davis III, the rheumatology practice chair at the Mayo Clinic in Rochester, Minnesota.
“This has several likely explanations. First, our treatment strategies have changed substantially. We start treatments much earlier after the onset of disease than in the past. Second, we treat more aggressively, striving to attain low levels of inflammation in the joints as soon as is practically possible. Third, the advent of biologics — drugs that contain antibodies or proteins that, when injected into the body, potently decrease inflammation — has also contributed to the prevention of joint damage,” Davis says.
“The importance of early diagnosis and effective treatment using disease-modifying drugs cannot be overstated,” Davis stresses. “It is crucial to start treatment within six months of disease onset to get the best chance of preventing progression of joint damage and of improving the chances of putting RA in remission.”
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Dr. Roger Kornu, a rheumatologist with the University of California, Irvine, agrees. “We just don’t see the problems that we used to see 20 years ago. In managing RA, we are proactive, meaning that we are able to treat [the disease] early and possibly prevent further joint damage.”
Although the majority of individuals with RA get good response from aggressive, early treatment strategies, some people do not respond to treatment and can still experience disfigurement of the hands and feet that can interfere with daily functioning.
Surgery is one option for individuals with advanced joint damage or degeneration. This can involve replacement of finger and ankle joints, or fusion of the wrists and ankles.
The potential benefits and risks of surgery “depend to a great extent on the unique circumstances of the patient,” according to Davis, who stresses the importance of consulting with an orthopedic surgeon for people with advanced joint damage or degenerative RA who have persistent pain or loss of function.
For less severe pain and disfigurement, treatment options include the use of over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen or aspirin, ice and injections of steroids directly into the joints.
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Other assistive devices can also be helpful.
“We still do use braces and splints for the wrist joints and finger joints in patients who do have joint damage,” Davis says. “And we often need to use shoe inserts or orthotics to manage foot [or] ankle deformities.”
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Disfigurement of the Hands and Feet in RA May Be a Thing of the Past originally appeared on usnews.com
