Rheumatoid Arthritis of the Foot and Ankle

Article featured on OrthoInfo

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body. More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Description

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

How It Happens

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes an overactivity of this lining. It swells and becomes 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.

In RA, the lining of the joint swells and becomes inflamed. This slowly destroys the joint.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to the blood vessels, nerves, and tendons. Deformities of the hands and feet are the more obvious signs of RA. In about 20% of patients, foot and ankle symptoms are the first signs of the disease.

Statistics

Rheumatoid arthritis affects approximately 1% of the population. Women are affected more often than men, with a ratio of up to 3 to 1. Symptoms most commonly develop between the ages of 40 and 60.

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. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who inherit RA.

Symptoms

The most common symptoms are pain, swelling, and stiffness. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot.

Anatomy of the foot and ankle

Anatomy of the foot and ankle.

Ankle

Difficulty with inclines (ramps) and stairs are the early signs of ankle involvement. As the disease progresses, simple walking and standing can become painful.

Hindfoot (Heel Region of the Foot)

The main function of the hindfoot is to perform the side-to-side motion of the foot. Difficulty walking on uneven ground, grass, or gravel are the initial signs. Pain is common just beneath the fibula (the smaller lower leg bone) on the outside of the foot.

As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. This can result in a flatfoot deformity. Pain and discomfort may be felt along the posterior tibial tendon (main tendon that supports the arch) on the inside of the ankle, or on the outside of the ankle beneath the fibula.

Midfoot (Top of the Foot)

With RA, the ligaments that support the midfoot become weakened and the arch collapses. With loss of the arch, the foot commonly collapses and the front of the foot points outward. RA also damages the cartilage, causing arthritic pain that is present with or without shoes. Over time, the shape of the foot can change because the structures that support it degenerate. This can create a large bony prominence (bump) on the arch. All of these changes in the shape of the foot can make it very difficult to wear shoes.

Rheumatoid arthritis of the midfoot

This x-ray shows signs of RA of the midfoot. Note that the front of the foot points outward and there is a large bump on the inside and bottom of the foot.

Forefoot (Toes and Ball of the Foot)

The changes that occur to the front of the foot are unique to patients with RA. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). Although, each individual deformity is common, it is the combination of deformities that compounds the problem.

The bunion is typically severe and the big toe commonly crosses over the second toe.

Illustration of bunion and claw toe

People with RA can experience a combination of common foot problems, such as bunions and clawtoe.

There can also be very painful bumps on the ball of the foot, creating calluses. The bumps develop when bones in the middle of the foot (midfoot) are pushed down from joint dislocations in the toes. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. This creates clawtoes and makes it very difficult to wear shoes. In severe situations, ulcers can form from the abnormal pressure.

Severe claw toes can become fixed and rigid. They do not move when in a shoe. The extra pressure from the top of the shoe can cause severe pain and can damage the skin.

Doctor Examination

Medical History and Physical Examination

After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.

Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot (the underside of the forefoot). If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.

Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.

Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.

Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.

Imaging Tests

Other tests that your doctor may order to help confirm your diagnosis include:

X-rays. This test creates images of dense structures, like bone. It will show your doctor the position of the bones. The x-rays can be used by your doctor to make measurements of the alignment of the bones and joint spaces, which will help your doctor determine what surgery would best.

Computerized tomography (CT) scan. When the deformity is severe, the shape of the foot can be abnormal enough to make it difficult to determine which joints have been affected and the extent of the disease. CT scans allow your doctor to more closely examine each joint for the presence of arthritis.

Magnetic resonance imaging (MRI) scan. An MRI scan will show the soft tissues, including the ligaments and tendons. Your doctor can assess whether the tendon is inflamed (tendonitis) or torn (ruptured).

Rheumatology Referral

Your doctor may refer you to a rheumatologist if he or she suspects RA. Although your symptoms and the results from a physical examination and tests may be consistent with RA, a rheumatologist will be able to determine the specific diagnosis. There are other less common types of inflammatory arthritis that will be considered.

Nonsurgical Treatment

Although there is no cure for RA, there are many treatment options available to help people manage pain, stay active, and live fulfilling lives.

Rheumatoid arthritis is often treated by a team of healthcare professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.

Although orthopaedic treatment may relieve symptoms, it will not stop the progression of the disease. Specific medicines called disease-modifying anti-rheumatic drugs are designed to stop the immune system from destroying the joints. The appropriate use of these medications is directed by a rheumatologist.

Orthopaedic treatment of RA depends on the location of the pain and the extent of cartilage damage. Many patients will have some symptom relief with appropriate nonsurgical treatment.

Rest

Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without placing a large impact load on the foot.

Ice

Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done 3 or 4 times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin.

Nonsteroidal Anti-inflammatory Medication

Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. In patients with RA, the use of these types of medications should be reviewed with your rheumatologist or medical doctor.

Orthotics

An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot. The primary goal is to minimize the pressure and decrease the pain and callous formation. This is more effective for deformity in the front and middle of the foot/

For people with RA, hard or rigid orthotics generally cause too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.

Braces

A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed. The brace can be a very effective device for some patients, allowing them to avoid surgery.

Ankle brace

A custom-molded leather brace can be effective in minimizing the pain and discomfort from ankle and hindfoot arthritis.

Steroid Injection

An injection of cortisone into the affected joint can help in the early stages of the disease. In many cases, a rheumatologist or medical doctor may also perform these injections. The steroid helps to reduce inflammation within the joint. The steroid injection is normally a temporary measure and will not stop the progression of the disease.

Surgical Treatment

Your doctor may recommend surgery depending upon the extent of cartilage damage and your response to nonsurgical options.

Fusion. Fusion of the affected joints is the most common type of surgery performed for RA. Fusion takes the two bones that form a joint and fuses them together to make one bone.

During the surgery, the joints are exposed and the remaining cartilage is removed. The two bones are then held together with screws or a combination of screws and plates. This prevents the bones from moving.

Because the joint is no longer intact, this surgery does limit joint motion. Limited joint motion may not be felt by the patient, depending on the joints fused. The midfoot joints often do not have much motion to begin with, and fusing them does not create increased stiffness. The ankle joint normally does have a lot of motion, and fusing it will be noticeable to the patient. By limiting motion, fusion reduces the pain.

Fusion can be a successful technique. However, because patients with RA also show damaged cartilage and loose ligaments, the success rate of this type of surgery is lower in patients with RA than in patients without RA. The use of newer generation medication can slow the progression of the disease and impact the type of surgeries that can be performed successfully.

Other surgeries. The front of the foot is where there are more surgical options for some patients. Surgeons can now perform joint sparing operations to correct the bunion and hammertoes in some patients. Your surgeon will review the most appropriate options for your case.

Ankle

Ankle fusion and total ankle replacement are the two primary surgical options for treating RA of the ankle. Both treatment options can be successful in minimizing the pain and discomfort in the ankle. The appropriate surgery is based upon multiple factors and is individualized for every patient.

Ankle fusion and ankle replacement

This patient had arthritis of the hindfoot. It was treated by fusing all three joints of the hindfoot (triple fusion). An ankle replacement was also done in order to improve mobility and avoid the severe stiffness that would result from another ankle fusion. The ankle replacement implants can be seen here from the front and the side.

Patients with severe involvement of other joints around the heel or patients who have previously undergone a fusion on the other leg, may be more suited for ankle replacement. In addition, patients who have fusions within the same foot may be more suited for an ankle replacement.

Newer generation ankle replacement implants have shown promising early results. Ankle replacement implants have not yet been shown to be as long-lasting as those for the hip or knee, due to the fact that the newer generation of implants have not been available long enough to determine how long they will last.

Ankle fusion

These x-rays show an ankle fusion from the front and the side. The number and placement of screws and the use of a plate are dependent upon the surgeon’s technique.

Following ankle fusion, there is a loss of the up and down motion of the ankle. The up and down motion is transferred to the joints near the ankle. This creates a potential for pain in those joints, and possibly arthritis.

Patients are able to walk in shoes on flat, level ground without much difficulty after an ankle fusion, despite the loss of ankle motion. The joints in the foot next to the ankle joint allow for motion similar to the ankle joint, and help patients with fused ankle joints walk more normally.

Arthritis in subtalar joint

Over time, the increased stress that is placed on the rest of the foot after an ankle fusion can lead to arthritis of the joints surrounding the ankle. This patient had pain in the subtalar joint (arrow) and required an additional fusion of that joint to minimize the pain. Increased stress on other joints is the most concerning problem following ankle fusion.

Hindfoot (Heel Region of the Foot)

A fusion of the affected joints of the hindfoot is the most common surgery used to treat patients with flatfoot or arthritis of the hindfoot. A triple arthrodesis is a fusion that involves all three joints in the back of the foot. Occasionally, the joint on the outside of the foot is not fused if there is minimal to no involvement of that joint (this is at the surgeon’s discretion). This type of fusion eliminates the side-to-side motion of the foot, while preserving most of the up and down movement.

If RA is only in one joint, then a fusion of just that affected joint may be all that is needed.

Ankle fusion

(Left) In this x-ray, two of the three joints in the hindfoot have been fused. (Right) Just the subtalar joint is fused in this x-ray.

Any fusion of the hindfoot will limit side-to-side motion of the foot. This will affect walking on uneven ground, grass, or gravel. There is no method to replace the joints of the hindfoot.

Midfoot (Middle of the Foot)

Fusion is the most reliable surgical method to treat RA of the midfoot joints. If the shape of the foot is not normal, surgery is designed to help restore the arch and minimize the prominences on the foot.

There are joint replacement implants available for joints on the outside of the midfoot. This may preserve some midfoot motion. However, the use of these implants is at the surgeon’s discretion. These implants are not available for the joints on the inside of the midfoot.

Although the foot cannot be returned to a normal shape, the goals are to reduce pain in the foot and improve the potential for the patient to wear more normal shoes.

Reconstruction of collapsed arch

(Top) This x-ray shows RA of the midfoot that has collapsed the arch. (Bottom) The surgical reconstruction involved a fusion of the middle of the foot with plates and screws.

Forefoot (Toes and Ball of the Foot)

The choice of treatment for patients with a bunion or lesser toe deformities (hammer or claw toes) depends on a number of factors.

If the disease is very mild, joint-sparing procedures that preserve motion can be considered. The decision is dependent on the medication that the patient is taking and the amount of damaged cartilage that is present. A fusion of the great toe may be recommended despite that fact the bunion is very mild. If there is damage to the cartilage of the great toe joint, correcting the bunion will not minimize the arthritic pain.

If the RA has progressed and the lesser toes (two through five) have dislocated, a complex operation to minimize the pain and restore the shape of the foot may be recommended. The operation involves fusion of the big toe and removing a portion of bone of each of the metatarsals. This surgery removes the prominent bone on the bottom of the foot that is a source of the pain and allows the toes to re-align into a better position.

Occasionally, the lesser toe metatarsals can be preserved by shortening them to allow the toes to resume their position within the joints. This is not always possible, however, and the joint may have to be removed.

RA of the forefoot before and after fusion

(Left) RA of the forefoot. The big toe is deviated and crosses over the second toe, a typical appearance of a bunion. The lesser toes (two through five) are dislocated, resulting in painful and severe claw toes. (Right) This x-ray taken immediately after fusion of the big toe shows that the prominent bones on the ball of the foot were removed and the claw toes were corrected. The pins hold the toes in place while the soft tissues heal. The pins are removed in the office after 4 to 6 weeks with minimal discomfort.

To fix the bend in the toes themselves, the surgeon may suggest cutting a tendon or removing a small portion of bone of the toes to allow them to straighten. Pins that stick out of the foot are temporarily required and will be removed in the office after healing takes place.

There are some newer implants available that can be buried within the toes, which avoid the need for pins sticking out of the foot. These implants may not work if the bone is soft, or if significant destruction of the joints has occurred.

This operation puts a lot of stress on the blood vessels and skin of the foot. In severe cases, the toes may not survive the operation and may require amputation of a portion or the entire toe. This operation can provide the patient with a high level of function and the ability to enjoy a wider variety of shoewear.

Footwear

Reconstruction of the foot does not mean that a patient will be required to wear bulky and unappealing shoes every day. The patient shown here had both feet reconstructed. She is able to wear sandals and mild heels without difficulty. Although these types of shoes are not recommended all the time, they can be worn from time to time. Not all patients will achieve such an excellent result.

Preparing for Surgery

Many of the medications that help with RA also affect the ability of the body to heal wounds and fight infection. Your surgeon will work with your rheumatologist or medical doctor to review which of your medications will need to be stopped prior to surgery. Once the wounds are healed, the medication is typically resumed.

This period of time can be very difficult for patients with other areas of the body that are affected by RA. Many fusions require at least 6 weeks of time where no pressure can be placed on the foot. Making appropriate preparations to ensure you have help at home is crucial for success after surgery.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

RA Symptoms You Shouldn’t Ignore

Article featured on WebMD, Medically reviewed by Brunilda Nazario, MD

Rheumatoid arthritis can have many symptoms. The most common are stiff, painful joints and fatigue.

But this disease causes inflammation in many body parts, so you may have symptoms that you don’t realize are related to RA. Some are signs of serious complications that put your organs, or even your life, at risk.

If you have any of these symptoms, don’t try to deal with them on your own. Call your doctor right away.

Broken Bones

Both RA and medications to treat it, like steroids, cause your bones to become weaker. You’re more likely to break a bone if you fall. Exercise, especially weight-bearing activity like walking, helps to keep your bones strong.

Chest Pain

RA makes you more likely to get heart disease. Over time, plaque builds up in your arteries. Doctors call this atherosclerosis. This can lead to a heart attack. Chest pain is a common symptom.

RA is a possible cause of a painful heart problem called pericarditis. That’s when thin layers of tissue around your heart get inflamed. You may feel severe chest pain that’s easy to mistake for a heart attack.

Even though your chest pain may not be a heart attack, if you have it, call 911 or go to the emergency room right away.

Dryness

RA sometimes causes dry eyes. This makes you more likely to get an eye infection.

People with RA could get another autoimmune condition called Sjögren’s syndrome. It often leads to dry mouth, nose, eyes, vagina, or skin. Your lips or tongue may dry out, crack, and get infected.

Eye Problems

It’s rare, but RA can cause inflammation in the white part of your eye, called the sclera. The symptoms are mostly redness and eye pain. You might have blurry vision. If you notice these signs, see your doctor.

Work With Your Doctor to Prevent RA Complications

With RA, it’s important to treat more than just your joints. Talk to your doctor to tailor a plan.

Fever

It can be a sign of infection. RA medications like biologics and steroids slow down your immune system. While they ease joint pain and swelling, it’s harder for you to fight off bugs like the flu. RA makes you more likely to get an infection just because the disease wears down your immune system.

Mild fever is also one sign of an RA flare. That’s when inflammation gets out of control. If it gets too high, your doctor will check for infection.

Hearing Loss

There may be a slightly higher risk of hearing loss with RA.

Tinnitus, or ringing in your ears, can be a side effect of treatments like nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs).

Mood Changes

RA is tied to depression, anxiety, and other mood problems. That’s because the disease causes pain, fatigue, and stiffness that make it harder to do the things you enjoy. Depression and anxiety could also come from inflammation.

Some people with RA get fibromyalgia. This illness causes muscle pain and often leads to depression and anxiety. Stress makes all of your symptoms worse.

If your mood changes seem to take over your life, talk to your doctor. Depression and anxiety can become serious if you don’t treat them.

Numbness or Tingling

RA sometimes affects the small nerves in your hands or feet. They might feel numb or like you’re being stuck with pins and needles.

If these tiny blood vessels in your hands or feet shut down, your fingers or toes may feel cold or numb. They could even change color when it’s cold outside and look white, red, or blue.

Rheumatoid vasculitis, which affects blood vessels, can also cause numbness, tingling, burning, or pain in your hands or feet due to damaged nerves. If your hands or feet are so numb that they drop or go limp when you try to raise them, see your doctor right away.

Numbness and tingling are side effects of biologics, too.

Stomach Pain or Indigestion

RA and medicines used to treat it are linked to mouth and stomach ulcers, stomach bleeding, acid reflux, diarrhea, and constipation. Painful diverticulitis (inflamed pouches in your GI tract) and colitis (an inflamed colon) are also possible if you have RA.

RA drugs like NSAIDs often cause ulcers or an upset stomach.

Belly pain is sometimes a sign of a rare RA complication called rheumatoid vasculitis — when inflammation spreads to your blood vessels. Weight loss and lack of appetite are other symptoms. Vasculitis is serious, so see a doctor right away.

Trouble Breathing

If you have a hard time getting your breath and can’t figure out why, maybe RA is to blame. Some people with the disease, especially men who smoke or used to smoke, are more likely to get serious lung problems.

When RA inflammation causes scar tissue to form in your lungs, you might notice chronic cough, shortness of breath, fatigue, and weakness.

RA may inflame the tissue that lines your lungs. That can lead to shortness of breath or pain or discomfort when you breathe.

See your doctor right away if you have unusual breathing problems or a cough that won’t go away.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Why are my RA symptoms getting worse?

From WebMD, medically reviewed on October 8, 2020

Getting control of you moderate to severe rheumatoid arthritis can be difficult, here are some common reasons why.

You’re Having a Flare

Red, warm, swollen joints are inflamed. A flare is when inflammation in your body spikes. Your symptoms can get worse. You might also have a mild fever, fatigue, and feel sick all over. To treat a flare, your doctor might adjust your medicine to lower the inflammation. To feel better, get more rest and apply hot or cold packs to sore, swollen joints.

You’re Under Pressure

Stress, anxiety, and even depression are common with RA. It’s more than just a bad mood. Depression can make it hard for you to manage your symptoms. Stress tells your body to release cortisol, an anti-inflammatory hormone. But ongoing stress triggers too much cortisol. This makes pain feel worse. Find ways to relax, like yoga, bubble baths, or exercise.

Your Sleep Cycle Is Off

RA pain and sleep trouble are a vicious cycle. If you’re in pain, you can’t sleep well. If you don’t get enough rest, your symptoms get worse. Good habits can help you get the downtime you need. Use guided imagery to distract you from the pain. Take pain meds before bedtime so you can nod off more easily. Switch off your phone and bedside clock. Their lights can disturb your slumber.

Your Meds No Longer Help

Even if what you’re taking has kept your RA under control for a while, things can change. If your body starts to resist current treatments, your symptoms may get worse. Talk to your doctor. You may be able to change to a new treatment. If you’re on a biologic, they might add other rheumatoid arthritis drugs to get your symptoms under control.

You Have Another Disease, Too

As if RA isn’t enough to handle, you can get related conditions that cause similar symptoms. People with RA are more likely to get fibromyalgia, too. It causes chronic pain, fatigue, and tender points that mimic RA. Your doctor can diagnose fibro to be sure it’s the cause of your problems and suggest treatment.

You’re Out of Remission

The goal of RA treatment is to make disease activity stop or slow down greatly so you have few or no symptoms. Doctors call this remission. But it doesn’t always last. RA might return and get worse. Over the years, your symptoms can come and go. See your doctor to adjust your medications.

You Don’t Exercise Enough

RA joint pain and stiffness can make you want to stay on the couch. But if you don’t move your joints, your symptoms will get worse. Exercise actually helps ease RA pain and fatigue. Try to get some activity every day. Walk, bike, or swim to rev up your heart. Do range-of-motion stretches to keep your joints limber. Work your muscles so they stay strong.

You Just Had a Baby

RA symptoms often ease up when you’re pregnant. But this can end soon after delivery. It’s hard to care for a baby when you have severe joint pain and fatigue, too. Your doctor can prescribe treatments that control your symptoms but are also safe for your baby if you plan to breastfeed.

You’re Carrying Extra Pounds

Added weight puts more stress on inflamed joints, which leads to more pain. Too much fat in your body can release hormones that worsen RA inflammation.  Your treatments may not work as well if you’re overweight. Exercise daily, and get help from a nutritionist if you struggle to stay at a healthy weight.

You Smoke

If you have RA and smoke, you should quit! Smokers with RA who quit often see symptoms improve. Smoking raises the odds that you’ll get RA in the first place. It can also affect the way your RA drugs work. They may not control your symptoms like they should. And it can zap your energy so you don’t exercise, which could ease your joint pain. Quit smoking or get help to kick the habit.

You’ve Been Too Active

Exercise is good for your RA, but you can overdo it. If you’ve been active all day, take time to relax. Rest can cool inflamed joints and help you bounce back from fatigue. Take breaks so you don’t get hurt. A physical therapist can teach you how to protect your joints, prevent painful muscle spasms, and exercise safely.

You’re Low on Vitamin D

People with RA often have low levels of vitamin D in their bodies. If you don’t have enough, your RA could become more active. That can lead to painful inflammation and even bone loss over time. Low vitamin D can worsen pain and fatigue. Your doctor can test your blood to measure your levels. More time in the sun (with sunscreen) and supplements might give you what you need.

You Have an Infection

RA and the treatments you take for it make you more likely to get an infection. Your immune system is overworked already, so it’s hard for it to fight off common bugs. Even seasonal flu can trigger RA symptoms. It also puts you at risk for septic arthritis, which causes severe pain in your knees, hips, or shoulders. Get the vaccines that your doctor suggests, such as a yearly flu shot.

You Stopped Taking Your Meds

Maybe they’re too expensive. Or perhaps you felt better so you thought it was OK to ditch your meds. But symptoms may flare up if you stop your medications. Talk to your doctor. You might be able to switch to a drug that doesn’t have as many side effects, or take a lower dose.

You Were Diagnosed Late

Your RA symptoms may be worse if you had the disease for years before you knew it. If it isn’t spotted and treated early, inflammation can lead to joint pain, damage, and deformity that won’t get better. Physical therapy may help you move better and ease your pain. Surgery can also replace your damaged joint with a new one.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Everything You Need to Know about Fibromyalgia

From Medical News Today

Fibromyalgia is a common and chronic syndrome that causes bodily pain and mental distress.

Symptoms of fibromyalgia can be confused with those of arthritis, or joint inflammation. However, unlike arthritis, it has not been found to cause joint or muscle inflammation and damage. It is seen as a rheumatic condition, in other words, one that causes soft tissue pain or myofascial pain.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), around 5 million adults aged 18 years or over in the United States experience fibromyalgia, and 80 to 90 percent of fibromyalgia patients are women.

Fast facts on fibromyalgia:

Here are some key points about fibromyalgia. More detail is in the main article.

  • Fibromyalgia causes widespread pain, fatigue, and other types of discomfort.
  • Symptoms resemble those of arthritis, but fibromyalgia affects the soft tissue, not the joints.
  • The cause is unknown, but risk factors include traumatic injury, rheumatoid arthritis and other autoimmune disorders, such as lupus, and genetic factors.
  • There is no cure, but medications, exercise, acupuncture, and behavioral therapy can help relieve symptoms and improve sleep quality.

Symptoms

Common symptoms include:

  • widespread pain
  • jaw pain and stiffness
  • pain and tiredness in the face muscles and adjacent fibrous tissues
  • stiff joints and muscles in the morning
  • headaches
  • irregular sleep patterns
  • irritable bowel syndrome (IBS)
  • painful menstrual periods
  • tingling and numbness in the hands and feet
  • restless leg syndrome (RLS)
  • sensitivity to cold or heat
  • difficulties with memory and concentration, known as “fibro-fog”
  • fatigue

The following are also possible:

  • problems with vision
  • nausea
  • pelvic and urinary problems
  • weight gain
  • dizziness
  • cold or flu-like symptoms
  • skin problems
  • chest symptoms
  • depression and anxiety
  • breathing problems

Symptoms can appear at any time during a person’s life, but they are most commonly reported around the age of 45 years.

Treatment

Medical attention is needed because fibromyalgia can be difficult to manage. As it is a syndrome, each patient will experience a different set of symptoms, and an individual treatment plan will be necessary.

Treatment may include some or all of the following:

  • an active exercise program
  • acupuncture
  • psychotherapy
  • behavior modification therapy
  • chiropractic care
  • massage
  • physical therapy
  • low-dose anti-depressants, although these are not a first-line treatment

People with fibromyalgia need to work with their doctor to come up with a treatment plan that provides the best results.

Medications

Medications may be recommended to treat certain symptoms.

These may include over-the-counter (OTC) pain relievers. However, the European League Against Rheumatism (EULAR) issued a recommendation against using non-steroidal anti-inflammatory drugs (NSAIDs) to treat fibromyalgia in their updated 2016 guidelines.

Antidepressants may help reduce pain. Anti-seizure drugs, such as gabapentin also known as Neurontin, and pregabalin, or Lyrica, may be prescribed.

However, a review has suggested that patients often stop using these drugs because they are not effective in relieving pain or because of their adverse effects.

Patients should tell the doctor about any other medications they are taking to avoid side-effects and interactions with other drugs.

Exercise

A combination of aerobic exercise and resistance training, or strength training, has been linked to a reduction in pain, tenderness, stiffness, and sleep disturbance, in some patients.

If exercise is helping with symptoms, it is important to maintain consistency in order to see progress. Working out with a partner or personal trainer may help to keep the exercise program active.

Acupuncture

Some patients have experienced improvements in their quality of life after starting acupuncture therapy for fibromyalgia. The number of sessions required will depend on the symptoms and their severity.

One study found that 1 in 5 people with fibromyalgia use acupuncture within 2 years of diagnosis. The researchers concluded that it may improve pain and stiffness. However, they call for more studies.

Behavior modification therapy

Behavior modification therapy is a form of cognitive behavioral therapy (CBT) that aims to reduce negative, stress- or pain-increasing behaviors and improve positive, mindful behaviors. It includes learning new coping skills and relaxation exercises.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm