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J Korean Med Assoc > Volume 53(10); 2010 > Article
Yoon and Kim: Surgical treatment option in rheumatoid arthritis

Abstract

A large number of patients who are diagnosed with rheumatoid arthritis undergo a chronic and progressive course. Surgical treatment is often needed for these patients, who have not responded to medical treatment. The aim of surgical intervention in rheumatoid arthritis is to restore function and quality of life by preventing joint destruction, correcting deformity, relieving pain, and making cosmetic improvements. There are many surgical options, including synovectomy, osteotomy, arthrodesis, resection arthroplasty, joint replacement, surgeries for the treatment of the tendon involved (repair, transfer, graft), and cervical spine surgery (fusion or decompression). The selection of the optimal surgical option requires consideration of not only the articular status and the degree of regional deformity involved, but also the physical status and age of the patient. In addition, timely surgical intervention is important because a delay of surgery often results in poorer functional outcomes and an increase in postoperative complications. Early referral to orthopedic treatment can provide better functional outcomes for patients with rheumatoid arthritis. Precise prediction of the disease progress and selection of the optimal treatment option are needed for excellent results to be expected. Therefore, a cooperative and multidisciplinary treatment strategy should be made among the relevant teams, such as physical medicine, rheumatology, orthopedics, physical therapy, occupational therapy, social work, and psychology.

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Figure 1
(A) and (B) show radiographs of an elbow with rheumatoid arthritis. There is diffuse joint space narrowing and subchondral osteopenia; (C), (D) and (E) Arthroscopic synovectomy and debridement was perfomed. Arthroscopic findings show synovial hyperplasi and erosive change of cartilage. RH, radial head
jkma-53-889-g001-l.jpg
Figure 2
(A), (B) Wrist radiograph of a 56-year-old woman showing a destructive change in the wrist joint. (C) She complained of limitation of the third, fourth, and fifth fingers without trauma history. (D) Intraoperative finding showed rupture of EDC to the third, fourth, and fifth fingers. (E) The ulnar head was resected and EIP was transferred to the ruptured EDC. EDC, extensor digiti mini; EIP, extensor indicis proprius
jkma-53-889-g002-l.jpg
Figure 3
A 29-year-old woman with rheumatoid arthritis. (A) Anteroposterior radiograph of the right ankle shows arthritic change with a medial malleolar fracture caused by trauma. (B) The medial malleolar fracture was reduced and internally fixed with screws, and an ankle arthrodesis was performed simultaneously.
jkma-53-889-g003-l.jpg
Figure 4
(A) A 39-year-old woman with rheumatoid arthritis had severe arthritic changes and valgus deformity in the left knee joint. (B) Total knee arthroplasty was done and normal alignment of the lower limb was restored.
jkma-53-889-g004-l.jpg
Figure 5
(A) Both hips were affected by rheumatoid arthritis. (B) Total hip arthroplasty was done in the left hip.
jkma-53-889-g005-l.jpg
Figure 6
(A) Extension and (B) flexion radiograph of the cervical spine shows atlantoaxial subluxation. Note that the anterior atlantodens interval (arrow) is increased when the cervical spine is flexed.
jkma-53-889-g006-l.jpg


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