rheumatoid%20arthritis
RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a systemic autoimmune rheumatic disorder of unknown etiology.
It is the most common form of inflammatory arthritis.
Patient usually complains of joint pain and/or swelling with morning stiffness that lasts for more than an hour.

Goals of treatment are clinical & radiological remission of disease and to reduce functional limitations & permanent joint damage.

Surgical Intervention

  • Surgical referral should be done before damage or deformity becomes irreversible in the following cases:
    • Actual or imminent tendon rupture
    • Nerve compression (eg Carpal tunnel syndrome)
    • Stress fractures

Indications

  • Unacceptable levels of pain
  • Persistent localized synovitis
  • Worsening joint function (ie instability or severe loss of range of joint motion)
  • Progressive deformity

Benefits

  • Deformity prevention
  • Joint function improvement &/or prevention of further deterioration
  • Pain relief

Surgical Procedures

Arthrodesis

  • Advantage: Provides stability & relief from pain
  • Indication: Young, active patients with severe unilateral joint involvement
  • Contraindication: Involvement of contralateral hip

Arthroplasty

  • Total knee arthroplasty is the surgical treatment of choice in most patients with rheumatoid arthritis affecting the knees
    • Relieves pain & may increase range of motion in patients with advanced RA who did not benefit from synovectomy
  • Indication: Patients with rheumatoid arthritis class III or class IV without multiple joint, ipsilateral hip or ankle or contralateral or both knee involvement
  • Complications:
    • Deep wound infection
    • Involves multiple joints limiting rehabilitation
    • Poor tissue healing
    • Severe flexion contracture, joint laxity & osteopenia
  • Complications may be minimized by utilization of antibiotic-containing bone cement & optimize preoperative nutrition

Synovectomy

  • Indicated in cases of inappropriate response to pharmacologic management after 6 months
  • Disease should be limited to synovial membrane but may involve little cartilage or bone or if any narrowing of joint space as seen on radiograph
  • High failure rate was observed in advanced stages of rheumatic arthritis if late synovectomy is done
  • Arthroscopic knee synovectomy controls synovitis, improvement in pain & preserves existing range of motion
  • Advantages of arthroscopic synovectomy:
    • Minimal incision
    • Complete synovial resection
    • Decreased incidence of infection, hemarthrosis
    • Increased or maintained range of motion
    • Intact quadriceps muscle
    • Lesser postoperative physical therapy
    • Cost-effective with high patient acceptance

Other Procedures

  • Carpal tunnel release
  • Cervical C1-C2 fusion
  • Finger small joints fusion/arthroplasty
  • Joint replacement
  • Tendon reconstruction
  • Tendon transfers
  • Total joint arthroplasty
  • Tenosynovectomy
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Rheumatology digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Audrey Abella, 16 Oct 2018
Individuals with diabetes have a higher risk of osteoarthritis, rheumatoid arthritis (RA), and osteoporosis, according to a Danish study presented at EASD 2018.