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.
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 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.
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.