Chapter

Surgical management of rheumatoid arthritis: introduction and spinal involvement

Tom Cadoux-Hudson, Hemant Pandit, Ian McNab and Raashid Luqmani

in Rheumatoid Arthritis

Published on behalf of Oxford University Press

Published in print February 2010 | ISBN: 9780199556755
Published online May 2011 | e-ISBN: 9780191740213 | DOI: https://dx.doi.org/10.1093/med/9780199556755.003.0009

Series: Oxford Rheumatology Library

Surgical management of rheumatoid arthritis: introduction and spinal involvement

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Reconstructive surgery should be undertaken before the patient becomes severely incapacitated

Patients should be as fit as possible, with optimal synovitis control, correction of blood dyscrasia and adequate nutrition (normal albumin)

Active disease is not a contraindication to surgery, nor is use of corticosteroids and methotrexate

Mild atlanto-axial subluxation is present in 30% at diagnosis of RA. Progression is usually associated with neck pain, brachalgia and myelopathy

Progressive myelopathy is most likely to occur if the PADI (Posterior atlanto-dens interval) is 13 mm or less.

Soft collars are of little biomechanical use. They remind the patient that they have a neck problem, which may indirectly limit spinal cord damage

Delayed diagnosis of myelopathy, often associated with deformity such as basilar invagination or kyphosis, requires more complex and hazardous surgery.

Chapter.  3318 words.  Illustrated.

Subjects: Rheumatology

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