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Rheumatoid Arthritis
Rheumatoid arthritis is an auto immune disease which eventually leads to hypertrophy of the synovium into something called a pannus. This ultimately erodes the articular surface and causes ligaments to come loose from their attachments, which leads to joint subluxation and dislocations. As podiatrists, what we deal with is the end results of this process of degeneration.
Clinical Findings in RA
Stiffness in the morning more than 30 minutes ( poststatic diskenisia)
Less then 30 minutes is usually Osteoarthritis
Extraarticular manifestations of RA
Vasculitis Autoimmune reaction against your own blood vessels If the blood vessels that are affected are very large, can lead to gangrene and loss of healthy tissue. If the blood vessels are small p petechia-like changes within the skin will develop
don't blanche when pressure is applied
Extraarticular manifestations of RA
Rheumatoid nodules or cysts Rheumatoid nodules should not be operated on as they are non-inflammatory. Fade when you push on them. They usually occur at sites of compression. Rheumatoid cysts can be operated on.
Some of these will have an effect on your pre-, peri-, and postoperative care
Example: If a pt takes NSAIDs such as Aspirin, take into consideration
Increase in the bleeding. time aspirin has an irreversible affect on platelets discontinue the aspirin for 2 weeks pre-op. get the patient on another non-steroidal drug with more reversible effects.
Surgical approaches
Hoffman
Transverse plantar incision. Cut plantarly on all the met heads p pop out and cut off the heads in an even met parabola.
Clayton
Transverse dorsal incision
Problem with any transverse incision is that there are important structures that one risks destroying
lymphatics get interrupted Neurovascular structures might get interrupted also-- BE CAREFUL Chronic swelling and numbness are the complications.
Complications
Infections (staph, strep)
Preoperatively order, Ancef IV . 1 g 30 before the surgery
Skin slough
Local wound care post-op
Recurrent deformity
You have not cured RA. You have only relieved the symptoms