Aggressive RA Treatment May Prevent Joint Deformities

Thanks to earlier diagnosis and more effective treatments, joint deformities in people withrheumatoid arthritis (RA)are becoming less frequent and severe.

是什么导致风湿性关节炎的关节畸形?

In a joint affected by RA, inflammatory cells of the immune system gather in the lining of the joint (called synovium), forming a fibrous layer of abnormal tissue (called pannus). The pannus releases substances that quicken bone erosion, cartilage destruction and damage to the surrounding ligaments. The involved joints lose their shape and alignment, resulting in deformities. Severe deformities lead to loss of joint function and the need for joint replacement surgery.

畸形发展的危险因素包括高水平的c反应蛋白(CRP)，一种体内炎症的标志，以及类风湿因子(RF)，一种存在于许多RA患者血液中的抗体(免疫系统产生的特殊蛋白质)。

Common Joint Deformities in RA

• Boutonniere deformity:The middle finger joint bends toward the palm while the outer finger joint may bend opposite the palm.
• Swan-neck deformity:The base of the finger and the outermost joint bend, while the middle joint straightens.
• Hitchhiker’s thumb:The thumb flexes at the metacarpophalangeal joint and hyperextends at the interphalangeal joint below your thumb nail. It is also called Z-shaped deformity of the thumb.
• Claw toe deformity:The toes are either bent upward from the joints at the ball of the foot, downward at the middle joints, or downward at the top toe joints and curl under the foot.

Treating Joint Deformities in RA

Once deformities occur, treatments include exercise and splinting. For patients with severe hand disease, anoccupational therapistcan design an exercise program, as well as splints, to improve function and often slow the progression of deformity. To stabilize finger deformities, specially designed rings can be used as finger splints. To correct more severe finger deformities, finger joint replacement surgery may be necessary. Replacing damaged finger joints with artificial ones does not cure RA, but recovers joint function.

When RA affects the feet, the toes may become misshapen. If this makes walking or wearing shoes difficult, the deformities may be corrected withsurgeryor orthotics (such as simple cushioned insoles or custom-made cast devices). However, surgery is no longer common in people with RA, because available therapies work quite well. In many cases, it is now possible to prevent deformities by usingdisease-modifying antirheumatic drugs(DMARDs) andbiologic drugsbefore the loss of bone occurs.

AUTHOR: Denise Mann for the Arthritis Foundation

Related Resources:

• Understanding Your Arthritis Treatment Plan
• Rheumatoid Arthritis Treatment
• Arthritis Treatment: Early is Best
• Gut Bacteria: A Potential Game-Changer for Rheumatoid Arthritis