Rheumatoid Arthritis and Atypical Arthritidies-Rheumatoid Arthritis and Atypical Arthritidies Overview

Rheumatoid Arthritis and Atypical Arthritidies Overview
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This document provides a summary of the content on pages 467-490, which discusses different types of arthritis and their treatment. <br /><br />Rheumatoid arthritis is an inflammatory disease that affects over 2 million people in the US. It is characterized by pain, joint swelling, stiffness, and loss of function. The inflammation is caused by the proliferation of synovial cells in the joints and tendon sheaths, leading to osteopenia, joint fusion, deformity, and tendon problems. Treatment for rheumatoid arthritis includes the use of disease-modifying antirheumatic drugs (DMARDs) to inhibit TNF or IL-1 and reduce the need for surgery. Surgical treatment involves treating proximal disease before distal and stabilizing before mobilizing. <br /><br />In the wrist, deformities can involve radial deviation of the carpus and metacarpals, volar subluxation of the carpus, carpal autolysis/spontaneous arthrodesis, ulnar head prominence, and rupture of extensor tendons. The gold standard treatment for wrist deformity is total wrist arthrodesis, and limited arthrodesis may be possible in rare circumstances. <br /><br />Deformities of the MCP and IP joints occur as a result of synovial proliferation, destruction of cartilage and soft tissue, and fibrosis and scarring. Surgical treatment for MCP joints usually involves joint arthroplasty using silicone or pyrocarbon. Arthroplasty is performed with an incision followed by arthrotomy, release of collateral ligaments, and placement of an implant. Silicone failures may occur due to implant deformation/fracture or silicone synovitis. Treatment for IP joint deformities can include synovectomy with tendon repair or arthrodesis. <br /><br />Seronegative arthritis includes various types of arthritis that do not involve rheumatoid factor in the blood. Psoriatic arthritis is the most common seronegative type that primarily affects the hands. It is associated with skin and nail changes and can present as different forms of arthritis. Treatment involves NSAIDs and possibly methotrexate or cyclosporine, with surgical treatment based on symptoms and the joint involved. <br /><br />Crystalline arthropathy includes gout and pseudogout. Gout is caused by a malfunction in urate metabolism, resulting in high levels of uric acid in the body. It can manifest as arthritis due to uric acid precipitation in the joints. Treatment for acute gout involves medications such as indomethacin or corticosteroids, while chronic gout is treated with allopurinol or probenecid. Pseudogout results from calcium pyrophosphate dehydrate crystal precipitation in the joints. Treatment involves joint rest, NSAIDs, and cortisone injections. <br /><br />Juvenile idiopathic arthritis is a chronic arthritis that occurs in children under the age of 16. It has different subtypes and is treated with medications such as methotrexate, steroids, and sulfasalazine, along with hand orthoses and therapy. Surgical management is similar to adult rheumatoid arthritis. <br /><br />Infectious arthritis, also known as septic arthritis, is usually caused by bacteria in the joints. It presents with acute inflammation of a single joint, along with fevers and leukocytosis. Treatment involves joint drainage, irrigation, and IV antibiotics.
Keywords
arthritis
rheumatoid arthritis
inflammatory disease
treatment options
surgical treatment
wrist deformity
MCP joint deformities
IP joint deformities
seronegative arthritis
infectious arthritis