Rheumatoid Arthritis is a systemic disease which may cause inflammatory changes throughout the soft tissues of the body, not just the joints.
The cause of Rheumatoid Arthritis:
It is believed that Rheumatoid Arthritis is the result of our immune system mistakenly identifying the soft tissue membranes within the joints (the synovial membranes) as foreign bodies. This results in an inflammatory response by our body, as our immune system tries to defend the joints by destroying these protective synovial membranes. The synovial membranes are composed of connective tissue, so the immune system may turn against other connective tissue structures and organs, thus possibly affecting the entire body.
The most common joints that are affected in the feet are:
The metatarsophalangeal joints. These are the joints located in the balls of the feet (in the forefoot area) — the joints where the toes attach to the feet.
The interphalangeal joints. These are the toe joints.
The most common symptoms that one may experience are:
Prolonged stiffness in one or more joints (usually experienced in the same joints in both feet at the same time). This stiffness may last for one or more hours.
Aching pain which becomes more severe with use, and may not be relieved with rest, or may take a considerable amount of time to subside.
Classically this disease affects comparable joints on both feet at the same time. This is called bilateral or symmetrical joint involvement.
The affected joints appear swollen and inflamed. The swelling is usually a "soft" spongy type of swelling. There is also an increased warmth felt around the joint.
The affected joints are tender and/or painful when pressure is applied to them.
The range of motion of the affected joints is limited and painful.
The above symptoms are usually "migratory" in nature. One day one joint is affected, the next day a different joint.
The pathology of Rheumatoid Arthritis:
The synovial membrane within the joint becomes inflamed due to repeated attacks by our immune system. During these attacks a gritty substance is formed; it is called pannus. The pannus in turn erodes the cartilage, bone, and ligaments. This produces a "soft swelling" around the joint. Due to the erosion of the cartilage there is an even narrowing of the joint space. This causes bone to move against bone, which in turn causes pain within the joint. Eventually, the cartilage becomes completely destroyed and the bones fuse at the joint, producing a painful, swollen, inflamed, and motionless joint. In the balls of the feet we also find that the ligaments which hold the metatarsal heads in place are loosened or destroyed. This causes the metatarsal heads to drop, and become very prominent. They may become so large that they feel like rocks just under the skin, and they may produce deep and painful calluses. This makes walking painful and difficult.
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