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

ISBN: 9780199556755
Published online May 2011 | e-ISBN: 9780199607334 | DOI: http://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.  3306 words.  Illustrated.

Subjects: Rheumatology

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