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Rheumatoid Arthritis

Dr. Steven Rueda is one of the most sought after doctors for rheumatoid arthritis treatment in Palm Beach. This disease is one of the most common causes of arthritis in the wrist, hand, and fingers. It usually leads to painful joints and limited function of the hand and wrist. The damage from the disease typically worsens with time and can be very severe. Fortunately, treatment options have significantly improved in the past years leading to improved outcomes for all patients.

Rheumatoid Arthritis Symptoms and Diagnosis

The symptoms of rheumatoid arthritis are caused by the inflammation and damage to the joints, tendons, and ligaments. Some of the most common symptoms include:

 

  • Pain in the wrist joints, hand joints, and finger joints
  • Reduced movement in the wrist, hand, and finger joints
  • Lumps, swelling, and puffiness over the joints of the wrist, hand, and fingers
  • Deviated finger position
  • Tendon rupture with loss of motion at the wrist, hand, and finger joints
  • Swan-neck appearance to the finger
  • Boutonniere deformity of the finger

Most of the patients present with pain, swelling, and deformity. Rheumatoid arthritis typically affects more than one joint, and all these symptoms usually affect more than one joint.

The diagnosis is made using a combination of history, physical examination, and laboratory testing. Xrays are obtained to assess the degree of arthritis and determine the best course of treatment.

WHAT CAUSES Rheumatoid Arthritis?

The exact cause of rheumatoid arthritis is not known and is thought to be influenced by multiple factors including genetics. The disease is a known autoimmune condition in which the body attacks its own tissue and leads to all the classic symptoms. It primarily affects the lining of the joints (called the synovium), and with time leads to wearing of the cartilage in the joints. This wearing of the cartilage caps of the joints leads to bone-on-bone rubbing commonly known as arthritis. The disease not only affects the joints, but also can injure neighboring tendons and ligaments leading to ruptures, weakening, and tears of these structures.

Rheumatoid Arthritis Treatment Options

Treatment of Rheumatoid Arthritis requires a multi-specialty approach between internists, rheumatologist, and a hand surgeon. The disease has no cure and the main goal of treatment is to control its progression. The main forms of treatment are oral and intravenous medications. These medications include ibuprophen, steroids, methotrexate, and newer biologic medications. These all work by reducing the body’s immune response that causes the damage to the affected tissues.
Steroid injections are an excellent choice for pain control in patients with Rheumatoid Arthritis. It works by reducing inflammation in the joint. These injections can provide pain relief in the injected joint for weeks to months. Dr. Rueda performs his injections with ultrasound guidance to ensure precise placement of the medication and optimize results.
Surgery is indicated for those patients who have developed significant arthritis despite medical treatment.

Rheumatoid Arthritis Procedure

Surgical treatments include: synovectomy, joint denervation, joint replacement (implant arthroplasty), joint fusion (arthrodesis), and tendon procedures.

This surgical procedures is ideal for patients who have had joint or tendon inflammation for several months and have had a poor response to medications. This procedure can only be performed before arthritis and cartilage wear has set in. An incision is made over the affected joint and tendon and all the inflamed tissue is removed visually. Recovery and down time usually do not exceed 1-2 weeks.

As the name suggests, this procedure removes the nerves that supply sensation to the joints. This helps reduce or eliminate pain at the joint without needing implants or joint fusion. An incision is made over the joint and all the nerve branches going into the joint are removed leaving the main nerve intact. Recovery and down time usually do not exceed 1-2 weeks.

In some cases arthritis is so advanced that the cartilage in the joints is completely worn. The bone-on-bone rubbing leads to symptoms of pain and cracking. In these cases, a new joint can be created with the use of an implant like its done for knee and hip replacements. These surgeries are excellent for removing and reducing pain without sacrificing movement. There are implants available for the wrist joints and finger knuckles. These implants are ideal for patients who have low demand on their hands. The recovery from surgery is usually 2 weeks, and a removable splints is worn for 6 weeks while the tissue heal after the implant placement. (See Image)

Joint fusion the last step in the ladder of surgery for patients with Rheumatoid Arthritis. It gets rid of arthritis pain by fusing or joining the bone ends that have the worn cartilage. This avoids bone-on-bone rubbing as there is no movement after the bones heal. It is ideal for patients who have higher demand on their hands, or those who want a definitive and final way to treat the symptoms. The downside to this procedure is that is sacrifices movement in exchange of better pain. The recovery from surgery is usually 2 weeks, and a cast is worn for 6 weeks while the bones fuse. 

It is common to see finger deviation in patients with Rheumatoid Arthritis. Some of the most common are Boutonniere and Swan-Neck deformity. Surgery rebalances the tendons and tissues in the finger to re-establish the normal mechanics of the finger. In cases of tendon rupture, repair may be done with tendon transfers or grafts from other areas.

RECOVERY AND DOWNTIME

  • Synovectomy and Joint Denervation: Outpatient procedure. Most patients are actually surprised at having less pain than they expected. There is tightness, swelling and bruising for first few days after surgery. An elastic bandage is applied and removed in 2-5 days. The patient begins therapy to gradually increase the movement in the joint.
  • Joint Replacement and Joint Fusion: Outpatient procedure. Patients receive a nerve block to minimize pain after surgery. There is tightness, swelling and bruising for 2-3 weeks after surgery. A splint is worn for 2-6 weeks. The patient begins therapy to gradually increase the movement in the joint after splint removal.
  • Soft Tissue Procedures: Outpatient procedure. There is tightness, swelling and bruising for first few days after surgery. Most patients keep a splint for 2-3 weeks but begin therapy immediately to preserve hand and wrist mobility.

  • Synovectomy and Joint denervation: Most patients generally return to work in 1 week when the incision is healed. Weight lifting and heavy manual exercise is not allowed until 3 weeks after the surgery.
  • Joint Fusion and Replacement: Return to work depends on the activity and profession. Those whose labor requires strong manual activity usually return to work for basic tasks in 2 weeks.

Why Choose Precision Hand Center for your Rheumatoid Arthritis Procedure?

Dr. Rueda, a Hand Fellowship trained surgeon who has 7 years and 2,000 procedures of experience will be your safe and best choice for rheumatoid arthritis. Successful results in this procedure requires a surgeon that is experienced and knowledgeable in hand surgery and hand anatomy. Dr. Rueda has published articles in expert peer reviewed journals and his work has been presented in several national conferences. Dr. Rueda’s passion for patient education and custom centered approach will guarantee you feel comfortable every step of the way. Dr. Rueda also believes in treating his patients as if he was treating his own family; you can trust you will enter a trusting and long-term relationship and have some of the best rheumatoid arthritis treatment Palm Beach can offer.

FREQUENTLY ASKED QUESTIONS (FAQ)

It is important for the patient to establish contact with a hand specialist as soon as possible in the disease process. Although surgery will typically not be needed for years or months, the hand specialist will follow the progress of the disease. Many times rheumatoid arthritis patients seek the help of a surgeon very late in their process, after facing unnecessary pain that could have been relieved earlier. It is also common to see the patient have devastating complications from the disease that could have been avoided if the hand specialist had been following up frequently. Many times procedures can be performed that control the disease or prevent devastating complications prior to their occurrence.