Limited Options for Rheumatic HandsDoctors find that patients tend to fall into three groups. The first group are the optimists who are happy no matter how poor the results of their treatment. The second group are pessimists who report poor results even when the doctors think that things look good. In the third group, everything is "just right" -- the results and the patient's report match.
Hand surgery specialists at the University of Cincinnati find themselves in a different group altogether. They report the results of adults receiving new finger joints for severe rheumatoid arthritis. They see poor results and aren't happy. It seems that joint implants don't hold up in the long-run. Implant fracture, bone erosion, and shortening of the bones occur in almost all of the patients.
Each patient had all four metacarpophalangeal (MCP) joints replaced. The MCP joints are the knuckles at the base of the fingers. They stick out when you form a fist. At first motion is better and function is improved. But over time the motion gets worse, the fingers start to drift to the side, and the patient can't use the hand for daily activities. Pain is present in about half the patients.
The good news is that treatment of rheumatoid arthritis has improved greatly with new drugs. These medications keep the arthritis from getting worse. The drugs are called disease-modifying anti-rheumatic drugs (DMARDs). With DMARDs, fewer patients end up needing joint replacements. Those who do have a better result than in the past.
The patients in this study were treated between 1980 and 1991. Today patients are healthier, and the MCP joint implants now outlive the patients. The authors think it's still worth it to replace deformed and painful rheumatic joints that are limited in motion. The implants do offer some help when nothing else is available.
Charles A. Goldfarb, MD, and Peter J. Stern, MD. Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis: A Long-Term Assessment. In Journal of Bone and Joint Surgery. October 2003. Vol. 85-A. No. 10. Pp. 1869-1878.
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