Treatment and management of rheumatoid arthritis, osteoarthritis and spondyloarthropathies

Treatment and management of rheumatoid arthritis, osteoarthritis and spondyloarthropathies in Hebbal, Bangalore

Rheumatoid Arthritis (RA)

Several drugs, like Cyclophosphamide, Cyclosporine, Azathioprine, Rituximab, Abatacept, etc., are given to manage rheumatoid arthritis patients. Besides such medications, surgical procedures are also performed when the drugs cannot help. The pain and immobility of the joints may be improved with a Synovectomy procedure that involves the removal of the synovial tissues present around the affected joints. 

Why is the Synovectomy procedure performed?

Those who don't improve on medications are treated with synovectomy procedures. The synovial membrane surrounding the joints gets swollen and doesn't respond to drugs. The fluid produced by the membrane keeps the joints moving, folding, rolling and extending. In RA, the quantity of this fluid increases, leading to swelling, tenderness, and warmth of the joints. 

Which joints are treated with Synovectomy?

The joints treated with a synovectomy procedure are the knees, ankles, hip, elbows, shoulder, wrist and fingers. 

How is Synovectomy Performed?

The open surgical procedure and arthroscopic procedure are both approaches. The patient is treated with general anaesthesia to perform the surgery. 

In the arthroscopic procedure, a minimal number of incisions is made. 

• The joint is tightened with a tourniquet to decrease the flow of blood. 

• The area is stretched out with the help of a pressure irrigation system.

•  The surgeon then inserts an ‘arthroscope’ or a tiny camera inside the joint. 

• This makes the synovium visible for the surgeon to remove it successfully.

After surgery

The recovery time is faster with arthroscopic synovectomy, and there is marked improvement in the pain and mobility of the affected joints. Physical therapy is the next course of action for the patient after a few days in which the physiotherapist works to help in increasing movement in the operated joints. 

Knee/Hip Arthroplasty

Besides synovectomy procedures, knee and hip replacement procedures are also performed to tackle the affected knees and hips. Here the damaged parts of the knees or hips are removed and replaced with artificial components, either metal or plastic. 

Before knee or hip arthroplasty procedures, the patient undergoes blood tests, physical examination, dental examination and an Electrocardiogram. 

Knee arthroplasty procedure

The different steps involved are listed as follows,

• General or local anaesthesia to numb the area

• The knee is cut open with an incision. 

• The damaged knee is removed along with any cartilage. 

• The knee implant is placed within. 

• Cement may be used to secure the implant.

• Plastic pieces are inserted in between the metallic knee parts for smoother movements.

• The incision is closed.

After the Procedure

Medications such as painkillers and blood thinners are administered to the patient after surgery. Compression devices for periodical compression of the replaced knee are also provided—physical therapy to help move and adjust to the new knee. 

Osteoarthritis (OA)

Medications such as analgesics, anti-inflammatory drugs (NSAIDs), Opioids, capsaicin creams, steroids, etc. are temporary treatments for the control of Osteoarthritis. Also called Degenerative Joint Disease (DJD), the tendons are degraded in the joints and disintegrate the cartilage and connecting ligaments. This leads to severe pain, inflammation and deformation within the joints. 

The alternative treatment measures for OA include cold or hot compression, weight management, exercises, and supportive objects like canes, braces, orthotics, inserts within the shoes, etc. 

Injection of intra-articular therapy liquids such as Hyaluronic acid and steroids is another approach to treating OA patients of varying severity. The other surgeries performed in case of no response to the above treatment measures include the following.

• Osteotomy

This is a particular surgery that is used in the re-shaping of bones with different cuts and improvements. The bone is usually lengthened or shortened to fit into the concerned joint. Many types of osteotomies are performed on the various joints of the body.

• Knee osteotomy

Here the damaged knee cap is shaped and cut in a manner that will inflict minor pain during its movement. The upper shinbone called the tibia, or the lower thighbone, also called the femur, is subject to reshaping during surgery. A knee osteotomy considerably lowers the pressure on the damaged knee side. 

• Spinal Osteotomy

The surgery focuses on removing a wedge-shaped piece of the spinal column to correct a hunchback or swayback. 

• Hip Osteotomy

In this Spondyloarthropathies treatment in Hebbal, Bangalore, the hip socket is re-shaped by the surgeon so that the hip socket can cover the ball in the joint more efficiently. 

• Jaw Osteotomy

This is called a mandibular osteotomy and involves aligning the lower into a proper position. Hence the person can now bite efficiently with a well-balanced jaw.

• Chin Osteotomy

This type of osteotomy involves the narrowing of a broader chin.

• Larger toe Osteotomy

A large toe is kept from colliding with the other by removing a piece of bone from it and straightening it up.

Procedure steps

• The surgery begins with localised or general anaesthesia, depending on the area to be operated on. For hip, spinal or knee osteotomies, general anaesthesia is given whilst local anaesthesia is given for the other types.

• The surgeon then makes a small incision on the site and measures the bone with the help of special wires. 

• A small section of the bone is then taken out using a surgical saw. 

• The new space is filled up with another smaller piece of bone to realign and ease any pressure felt. 

• The space may also be filled using a bone graft from the pelvis. 

Recovery from an osteotomy

The recovery process from an osteotomy is slow and lengthy, and it may take several months for the bone to heal. Physical therapy is usually recommended to strengthen the surrounding muscular tissue. 

Joint Fusion is another type of surgery that may be performed to treat OA. Here the bones are connected with the help of metal plates, screws and pins so that a continuous joint is formed. The joint bones then fuse with the joint over a long period. This can reduce the pain felt in the Osteotitic joints to a great extent. 

Spondyloarthropathy

This is a form of arthritis that involves the areas in which the tendons and ligaments within the ‘Enthesis’ are connected to the bones. A collection of rheumatic diseases that involves swelling of the vertebral column and associated joints are known as Spondyloarthropathies. They include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, inflammatory bowel syndrome and undifferentiated spondyloarthropathy. The backbone, hips and shoulders are predominantly damaged in this group of diseases. 

• Reactive arthritis

This usually occurs after the patient gets affected by either a digestive system infection or a urinary tract infection. The joints situated in the lower part of the body are affected.

• Reiter’s syndrome

This form of reactive arthritis follows an infection in any other body part. The symptoms include swelling, redness, and pain in the joints such as the knees, ankles and feet.

• Enteropathic spondyloarthropathy

Inflammatory bowel diseases like ulcerative colitis or Crohn’s disease sometimes lead to an inflammatory spondyloarthropathy called enteropathic spondyloarthropathy. 

• Ankylosing spondyloarthropathy is a type of arthritis that leads to severe back pain.

• Psoriatic arthritis

• Undifferentiated spondyloarthropathy

Treatment for spondyloarthropathies

Although there is no cure for these diseases, they can be managed with the following drugs.

• Non-steroidal Anti-inflammatory Drugs (NSAIDs)

• Corticosteroid injections.

• Disease-Modifying Antirheumatic Drugs (DMARDs)

• Tumour Necrosis Alpha Blockers.

• Aerobic exercises.

• Neuromuscular exercises.

• Strength training.

• Resistance training.

Book an appointment at Manipal Hospitals now to get consultaio from the best doctors at Bangalore.