Walking is just not the same as it used to be. In an earlier post, rubbery legs were mentioned. Knees with damaged cartilage cause them to buckle and make it difficult to climb stairs. Tender toe and ankle joints make walking slow. Stiffness in the joints caused by inflammation cause an awkward gait. But these symptoms pale in comparison to what RA is doing to my Achilles tendons.
When joints become inflamed during RA, tissue damage on many fronts can occur. Most people familiar with RA are aware that hard bone tissue can become eroded (like has occurred in my finger joints). But joints are a conglomeration of multiple tissues such as bone, cartilage, and tendons and all can be damaged from RA-induced inflammation. Cartilage protects bones from rubbing on each other. Tendons connect muscles to bones.
Generally speaking, inflammation in a tendon is called tendonitis.[i] Many people experience tendonitis from repetitive use…have you ever gardened too long and had painful hands afterwards? Or think tennis elbow. In RA, ongoing tendon inflammation is caused by the messed up immune system attacking the tissues. According the Johns Hopkins website on rheumatoid arthritis, “Persistent tenosynovitis and synovitis leads to the formation of synovial cysts and to displaced or ruptured tendons.”[ii] Soft tissues, including tendons, can be damaged by RA. Many people with RA have tendonitis of the flexor tendon in the hand. When tendons are damaged, movement becomes difficult if not impossible.
In 2006, before an official RA diagnosis, I experienced chronic tendonitis in my Achilles tendons, the largest tendon in the body that connects the calf muscles to the heel. After a long history with conservative treatments that didn’t help (ice, ibuprofen, rest), an orthopedic surgeon discovered via MRI that I had a partially torn tendon. He performed surgery (see photo of one of the scars) to repair the tear and even “lengthened” the tendon by disconnecting it from the muscle and reattaching it lower down the leg. This is called a gastroc slide procedure[iii]…think of taking the tension off a rubber band. The tears in the tendons were attributed to my build and genetics. Within a year, the other ankle had the same problem and another surgery was in order. Long story made short…additional symptoms of RA appeared and the puzzle began to be put together. My primary care doc was the first to connect the Achilles tendon problems with potential autoimmunity and a diagnosis finally came after seeing a rheumatologist. Now I knew the reason for the tendon problems.
Hope that the surgeries repaired my Achilles tendons forever was shot down by the fact that, despite being on disease modifying drugs (currently Humira) designed to slow down inflammation, they continue to be tender, swollen, stiff, and painful, with heel spurs forming. During a flare, my tendons are among the first to “scream” at me. Movement of my legs is just not what is used to be and I oftentimes find myself walking in a stiff way that avoids stretching the Achilles tendon and calf muscles. Of the myriad RA symptoms, this indeed has become my “Achilles heel”![iv]
Photo #1 Credit: Creative Commons License http://www.flickr.com/photos/natashavora/