Rheumatoid Arthritis and Atypical Arthritidies-Case: Rheumatoid Arthritis and Atypical Arthritidies

Case: Rheumatoid Arthritis and Atypical Arthritidies

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This document discusses the case of a 63-year-old female teacher with rheumatoid arthritis in her metacarpophalangeal joints. Despite taking methotrexate for symptom control, she is experiencing increasing deformity in her hands and is considering surgical options. The initial evaluation includes the need for additional information, physical examination, and radiographic findings. There is a question about whether adjacent joint deformity should influence the treatment algorithm, and if methotrexate increases the rate of post-operative complications. Counseling the patient regarding postoperative expectations is also important.<br /><br />The document briefly mentions silicone MP arthroplasty as a possible surgical approach for this patient. The surgical approach and the importance of soft tissue structures for implant stability are discussed. There are concerns regarding which digits should be implanted.<br /><br />The post-operative course includes descriptions of post-op hand therapy prescription, the role of splinting, and the progression of activities. The follow-up appointments are important for monitoring progress and looking for any issues.<br /><br />In summary, medical management of rheumatoid arthritis has improved and decreased the severity of hand deformities. The reconstruction of joints proceeds from proximal to distal. Preoperative cervical spine radiographs are helpful in evaluating atlanto-occipital instability.

Keywords

rheumatoid arthritis

metacarpophalangeal joints

methotrexate

surgical options

adjacent joint deformity

post-operative complications

silicone MP arthroplasty

soft tissue structures

post-op hand therapy

splinting