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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