Updated: Aug 13, 2018
According to the Arthritis Foundation, almost 53 million adults in the U.S. suffer with some sort of arthritis, making it the nation’s number one cause of disability (2). So, whether you have suffered with it, or know someone else that does, you have likely seen the implications that arthritis can have on a person and their quality of life. Therefore, with May being National Arthritis Awareness Month, I wanted to take the time to recognize some of the arthritides that can affect the lower extremities. This is a short list compared to the over 100 known types of arthritis and their related diseases, so I encourage anyone interested in learning more about arthritis, to visit the Arthritis Foundation online (5).
Osteoarthritis (OA) a progressive joint disease that results from the wear and tear of cartilage (aka the cushion) between any two bones in the body (aka joints). In the lower extremity, the knees, ankles, and big toe joints are common areas to develop OA. It is often associated with advanced age because the more miles and stress we put on our bodies the more the cushion tends to wear out; however, trauma and abnormal biomechanics can also lead to OA.
Morning stiffness is common, but usually only lasts minutes. Joint pain and swelling can also present after exercise. As the arthritis progresses, it may be painful or difficult to bend the affected joint(s), so certain tasks, such as squatting or bending over, might become challenging.
There is not a specific lab test used to diagnose OA. Careful listening to one’s symptoms, along with performing a comprehensive physical exam, can help diagnose OA. If the arthritis is severe enough, one may be able to feel grinding of the bones against one another when the affect joint is put through range of motion. Radiographs can also be taken, which may show narrowing (or loss) of the joint space, flattening of the involved bones, or even bone spurs.
Rheumatoid arthritis (RA) is an autoimmune disease that often affects the smaller joints of the hands and feet and is symmetrical in nature. So, if the feet are affected, that would mean both feet are involved.
Although RA and OA involve joint pain and stiffness, the morning stiffness associated with RA lasts longer (>30 minutes). As mentioned above, people with RA will experience joint pain in the joints of the hands or feet and it will be bilateral. And because RA is a systemic disease, it can affect other body systems, causing such things as fatigue and fever (4).
Like OA, there is no one lab test to confirm the diagnosis of RA. The diagnosis is made by combining the patient’s personal history and explanation of symptoms, as well as a physical exam and diagnostic testing. Listening to what joints are affected, how they feel, and when the symptoms arise, can give insight into the diagnosis. On physical exam, in its more advanced or severe stages, one may notice rheumatoid nodules on the hands and/or feet, or the fingers and/or toes may appear laterally deviated. Radiographs can be ordered but may not be helpful until later stages of the disease. Although there is not a specific lab test to diagnose RA, there are blood tests that can be done to measure the levels of inflammation in the body as well as other tests that look for certain antibodies that are commonly associated with rheumatoid arthritis (4).
Psoriasis is a skin condition that causes plaques of a red, scaly rash. According to the National Psoriasis Foundation, up to 30% of people that have psoriasis will eventually develop psoriatic arthritis (1). In the lower extremity, the knees, ankles, and toes can be affected by the arthritis (1,3).
Like the other types of arthritis, morning stiffness is common in people with psoriatic arthritis. One hallmark feature of psoriatic arthritis is swelling of their entire fingers and/or toes (aka sausage digits). Nail pitting may also be noted (1,3).
If psoriasis is present, psoriatic arthritis should be considered; however, a person can have multiple types of arthritis at a time, so it’s important to do a thorough work-up, including taking a detailed personal history, performing a comprehensive medical exam, and ordering any relevant radiographs and blood tests (similar to those for RA) (3).
Gout results from an accumulation of uric acid in joints. This happens because the body either produces too much urate or it cannot excrete it appropriately. Sometimes diet (e.g. high in purines) can increase one’s risk for developing gout or having a gouty attack. If the gout becomes a chronic issue, damage to joints can occur, thus causing gouty arthritis. In the lower extremity, the knee and big toe joint are common sites for gouty attacks.
Acute gouty attacks can cause the joint to become red, hot, and swollen. The area can become so painful that even having a bed sheet over the area is uncomfortable.
It is important to diagnose gout correctly as it can look like an infection (aka a septic joint). A uric acid level can be ordered, but this is not always reliable because gout goes through different phases. The best way to diagnosis it is to aspirate the joint, meaning pull fluid from the joint using a needle, and have the fluid analyzed for crystal formation.
DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.
1. About Psoriatic Arthritis. National Psoriasis Foundation. Retrieved from https://www.psoriasis.org/about-psoriatic-arthritis
2. May Is National Arthritis Awareness Month (New Blog). Arthritis Foundation. Retrieved from http://blog.arthritis.org/news/arthritis-awareness-month/
3. Psoriatic Arthritis. Arthritis Foundation. Retrieved from https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/
4. Rheumatoid Arthritis. Arthritis Foundation. Retrieved from https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/
5. Sources of Arthritis Pain: Different types of arthritis can cause different types of pain. Arthritis Foundation. Retrieved from https://www.arthritis.org/living-with-arthritis/pain-management/understanding/types-of-pain.php