With all the advances and forthcoming advances in the treatment of rheumatoid arthritis which have been landing at the feet of patients and rheumatologists over the past decade, we tend to forget that joint destruction still occurs despite the use of these expensive biologic agents. And so, the biopharmaceutical firms continue to pour billions of dollars into rheumatoid arthritis research.
And so, we will continue to need the skill and services of our friend, the orthopedic surgeon.
Despite recent advances in medical treatment (and we are talking about the aforementioned biologics: Enbrel, Remicade, Humira, Rituxan, Orencia, to name a few), surgery still plays a role in the clinical management of rheumatoid arthritis. Medicine might slow rheumatoid arthritis, and, in some patients, actually put the disease into remission; but medicines cannot reverse significant joint destruction. Surgery can allow patients with rheumatoid arthritis an opportunity to maintain function and feel better.
Before patient and doctor decide on surgery, they should consider what the goals of a surgery might be:
1. Will the surgery give pain relief?
2. Will the surgery improve function, allowing for at least a partial return to a more vigorous, past activity level?
Patient and doctor also must consider the timing of the proposed surgery. Of course, any surgical procedure has its risks and its benefits; therefore, surgery should be done only at the point when it is truly necessary. On the other hand, if a surgery is delayed for too long a period, the surgery might not be as successful. This is where the rheumatologist and orthopedic surgeon must work together.
Some of the more common surgeries for rheumatoid arthritis include the following:
1. Joint replacement. This involves removing the damaged joint (most commonly the hip or knee) and replacing it with an artificial joint. The life span of an artificial joint is approximately 10 to 15 years, depending on body weight and activity level. After that, a second surgery is required, but repeat surgeries are usually not as successful as the original. This is a case where timing is important.
2. Carpal tunnel release. This can relieve the pain of carpal tunnel syndrome.
3. Fusion of neck bones (cervical vertebral bodies). Some rheumatoid arthritis patients suffer from instability of the bones in the neck. Fusion gives stability and reduces the risk of spinal cord damage. It can also reduce flexibility of the neck.
4. Synovectomy. This involves removing the inflamed joint lining so that it does not have the opportunity to destroy the cartilage and bone of the joint. While this can be an effective surgery, the synovium (the tissue lining the joint) can grow back, requiring a repeat surgery.
Surgery certainly plays a role in the treatment of rheumatoid arthritis. There is no cure for rheumatoid arthritis, let alone a drug that consistently puts the disease into remission. Patients will continue to suffer deformities which will require an additional doctor involved in their care: the orthopedic surgeon.
Rheumatoid arthritis patients should talk to their rheumatologists if they feel they might benefit from surgery.
Published On: July 16, 2008