Introduction
Medical conditions that particularly impact bone and joint health can wreck the person’s routine activities, and such conditions are often debilitating and agonizing. It potentially deteriorates the patient's quality of life. The aim of treatment modalities for such joint and bone issues is to facilitate joint function so that the quality of life can be enhanced at least to a satisfactory level. Rheumatoid arthritis is one such condition with a prevalence rate of one to two percent, with an obvious preference for women over 55 years of age.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis is a peculiar medical condition that typically impacts the joint structure. The condition arises due to wrongly directly immune cells. Immune cells are supposed to work against pathogenic organisms (disease-causing microbes) or foreign bodies. But in rheumatoid arthritis, the immune cells get misdirected, consider their own cells as outsiders, and elicit immune responses against the bodily cells. The cells that make up the joint lining are targeted in rheumatoid arthritis by the immune cells. Knee, wrist, and shoulder joints are susceptible to developing rheumatoid arthritis.
Rheumatoid arthritis can impair the structural as well as functional status of the involved joint. The affected individual experiences joint deformities, soreness, compromised range of movements, joint stiffness, and general puffiness encircling the joint area. Rheumatoid arthritis flags alternative periods of improvement and exacerbation. In addition to the joint-specific manifestations, other symptoms like general tiredness, weight, and fever are reported in certain rheumatoid arthritis patients.
Studies have pointed out specific genetic associations that are capable of triggering the development of rheumatoid arthritis. Being overweight, being over 60, female, older age, and chronic smoking are some other known factors that can contribute significantly to rheumatoid arthritis.
Why Are Surgical Interventions Advised for Rheumatoid Arthritis?
Rheumatoid arthritis is generally tackled with the help of conservative strategies like supportive therapies and medications. Medications can be painkillers, anti-inflammatory drugs, biological agents, or steroids. Physical and occupational therapies are supportive strategies that can enhance joint functions. However, at times, rheumatoid arthritis fails to respond to these conservative treatment strategies and continues to deteriorate the joint, eventually precipitating a deformed and impaired joint. Surgical therapeutic interventions are advised during such situations to deal with the progressing joint destruction. In most surgical interventions, the arthritic, deformed bony structures constituting the joint are replaced and swapped with synthetic counterparts fabricated precisely to fit into the defective segment. While other surgical options work by modifying the joint structure without obliterating the natural joint structure.
What Are the Widely Preferred Surgical Interventions for Rheumatoid Arthritis?
Surgical approaches are not considered the first line of defense against rheumatoid arthritis. However, the resistant and defiant nature of rheumatoid arthritis may, at times, necessitate a surgical approach to enhance the patient’s quality of life and general well-being.
Some of the widely employed surgical modalities for tackling rheumatoid arthritis include the following techniques:
1. Joint Replacement Surgery:
As the name suggests, joint replacement surgery is a form of replacement where the defective, deformed, and nonfunctional joint components are stamped out, and the joint is restructured with synthetically made components that simulate the functional joint components. The synthetic components can be fabricated as plastic, ceramics, or metal. Vital joints like the shoulder and knee joints are advised for joint replacement surgeries. However, smaller toe joints can also be replaced if indicated. Joint replacements enhance the mobility of the joint. Being an extensive surgical procedure, joint replacement surgeries are also susceptible to developing risks or complications. However, the proper analysis of the patient's joint condition, general health, and the doctor’s expertise in carrying out the procedure can influence the success and outcome of the surgery.
2. Arthroscopy:
It is a peculiar technique that enables visualization of the internal joint structure and aids in treating rheumatoid arthritis. Therefore, it functions as a diagnostic and therapeutic intervention. In arthroscopy, a tiny tube-shaped instrument is introduced into the joint space through a small skin opening. Unlike joint replacement surgery, arthroscopy is less traumatic and minimally invasive. The instrument introduced into the joint space has an embedded camera, which enables the doctor to get a proper joint cavity visualization by projecting the image on an external screen. Inflammatory sources from the joint space can be effectively identified and eliminated. The less invasive nature of the procedure offers a quick recovery period. In addition to rheumatoid arthritis, arthroscopy is employed for dealing with various ligaments and cartilage problems in the joints.
3. Synovectomy:
Synovectomy is another surgical option advised for rheumatoid arthritis patients. The synovectomy procedure is restricted to synovial joints, where the joint cavity is paved with synovial lining and houses synovial fluid. In synovectomy, the joint lining that exhibits inflammation will be taken away. Once the point of inflammation is drawn out, the associated discomfort and pain collapse dramatically.
4. Arthrodesis:
Arthrodesis is a widely advised surgical option for joints deformed by rheumatoid arthritis. The deformed joint portions are drawn out, and the corresponding bony segments are made to merge and fuse. Arthrodesis compromises the range of motion. However, it reinforces the stability and alignment of the joints.
5. Tendon Transfer Surgery:
It is a less frequently employed technique for rheumatoid arthritis, where a functional tendon close to the joint with rheumatoid arthritis is employed to counterbalance the lost strength and stability of the affected joint. It is mainly preferred in small joints like finger joints and wrist joints. It often aids in alleviating the discomfort and soreness associated with the inflamed joint. In addition to tendon transfer, the tendon release procedure, wherein the tendon is relieved from its attachment, is employed in some instances as an effective measure to tackle inflammation.
Conclusion
Surgery for rheumatoid arthritis is gaining acceptance and global applicability because of its enhanced success rate. It provides an opportunity for patients who are troubled with rheumatoid arthritis to lead a quality life. Studies have revealed that with the formulation of surgical modalities for rheumatoid arthritis, the patients flagged an appreciable hike in their life expectancy. The type of surgical intervention is determined by taking into account other factors like the joint involved and the general health profile of the patient. Joint replacement surgery is often advised for individuals whose general health status is competent for an open and extensive surgical procedure. In severely sick patients, the minimally invasive approach is preferred over extensive surgical intervention. The basic strategy of the surgical approach is to enhance joint functionality, thereby offering quality life for rheumatoid arthritic patients who failed to precipitate fruitful results with other non-surgical techniques.
