Health TipsInvolvement Rheumatoid Arthritis in the Foot

Involvement Rheumatoid Arthritis in the Foot – Symptoms, and treatments of Involvement Rheumatoid Arthritis (RA) vary depending on the area of involvement. Rheumatic nodules occur in rheumatoid joints, subcutaneous connective tissues, and bone prominences. They can range in size from a few millimeters to several centimeters. Despite their pain-free appearance, rheumatoid nodules may become so large that they impair the movement of the underlying joint.

Treating Early Arthritis in Small Foot Joints

While earlier studies suggested that patients with early inflammatory arthritis were more likely to develop significant damage to their blood vessels, these new ACR/EULAR criteria may be more sensitive in identifying patients with rheumatoid arthritis. This is particularly true if early disease progression is suspected. Moreover, clinicians treating early inflammatory arthritis should look for synovitis in small joints of the feet.

RA typically involves small joints of the upper and lower extremities. The most common joints involved are metacarpophalangeal joints and proximal interphalangeal joints, but the 1st carpometacarpal joint is less frequently involved. Other joints involved are the metatarsophalangeal joints and feet/ankles. The wrist, elbow, shoulder, and knee are frequently affected. Axiomatic involvement is more common and includes erosion, subluxation, and deformity.

There are currently no studies on the prevalence of foot involvement in patients with RA in Pakistan. It is an understudied manifestation of RA and is likely to result in a higher missed diagnosis rate. Despite its unfavorable clinical characteristics, involvement in the foot is a common feature of RA, affecting 29% of people with the disease. It is also an independent manifestation, regardless of whether a patient is seropositive or negative for the disease.

Early Onset RA Affects Joint ROM Significantly

Early onset of RA affects joint ROM significantly. Early erosions occur in the wrist joint and second and third MCPJs, with finger joint involvement occurring less frequently. Finger joint involvement is uncommon compared to other joints. In a study of 119 patients with RA for less than five years, Adams et al. found that patients with RA had reduced wrist ROM in the dominant hand, but it was not significantly lower than that in the non-dominant hand.

Involvement RA in the lung is another common extra-articular manifestation. ILD is a significant cause of morbidity and mortality. In RA patients, interstitial pulmonary disease (ILD) presents with symptoms of chronic cough and dyspnea, especially when walking uphill or climbing stairs. These symptoms should not be ignored and should be investigated by a rheumatologist.

Early erosions are usually very small and undetectable. As the disease advances, the erosions may become visible on radiographs. As the disease progresses, joint space is lost symmetrically, causing deformities and alignment issues. In advanced stages, joint ankylosis develops. If left untreated, the disease may lead to permanent damage. If the deterioration continues, tenosynovitis can cause carpal tunnel syndrome.

RA Involvement can Lead to Loss of Articular Cartilage

Disease activity assessment is the key to RA management. Involvement RA involves inflammation of the synovium in the joints and may lead to articular cartilage loss and bone erosion, which can severely impair a person’s ability to perform daily activities. A patient with RA may have symptoms that mimic those of polymyalgia rheumatic, including fever.

Foot pain is a common symptom of RA. In addition to ankle pain, patients with RA may experience foot discomfort and bunions. Claw toes and “cocked-up” small toes are common symptoms of foot involvement. Interestingly, this area is rarely studied in clinical assessments of RA. Patients with foot involvement are almost twice as likely to develop walking disability as those with other joints.


Anaya, Juan-Manuel, et al. “Pulmonary involvement in rheumatoid arthritis.” Seminars in arthritis and rheumatism. Vol. 24. No. 4. WB Saunders, 1995.

Grassi, Walter, et al. “The clinical features of rheumatoid arthritis.” European journal of radiology 27 (1998): S18-S24.


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