Rheumatoid arthritis Discussion

Rheumatoid arthritis results in a variety of problems. In the adult, the process may progress through proliferative, destructive and reparative stages. Progression of disease is unpredictable: patients may have episodic or sustained episodes of inflammation. Joint problems include stiffness, instability, unnatural angulation and deformity. Tendon involvement may take the form of tendinitis, triggering and tendon rupture. Nerve compression syndromes and weakness are common. Conservative management includes medications, cortisone injections, adaptive devices and education regarding joint and skin protection. Prophylactic surgery may be indicated to prevent tendon rupture if tendinitis fails to respond to conservative management. Otherwise, surgery is indicated on a highly individualized basis to correct specific complications of the disease process. Synovectomy, joint replacement or fusion, tendon transfer and nerve decompression are all common components of reconstructive surgery for this disorder. After surgery, patients with rheumatoid are at particular risk for problems due to poor wound healing. Postoperative therapy is essential for most procedures, often for prolonged periods. Multiple operations may be needed, and prognosis is always guarded.

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