Rheumatoid arthritis
Musculoskeletal Research and Basic Science, Springer International Publishing Ag, ss.517-544, 2015
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2015
- Doi Numarası: 10.1007/978-3-319-20777-3_31
- Yayınevi: Springer International Publishing Ag
- Sayfa Sayıları: ss.517-544
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Rheumatoid arthritis is a chronic, systemic, inflammatory disease characterized by articular cartilage destruction, erosion, ligamentous laxity, and synovial enlargement. It causes serious deformities and disabilities by affecting especially the small and middle joints symmetrically. Cartilage degradation is a result of the chemical effect of free oxygen radicals and lysosomal enzymes, which are secreted by the cytokine-activated neutrophils. T and B lymphocytes, monocytes/synovial macrophages, neutrophils, mast cells, and synovial fibroblasts are all thought to play a role in the pathogenesis. Synovial inflammation may cause restrictions in range of motion and disabilities via the cartilage degeneration, bone erosion, and loss of joint integrity, and the quality of the life of the patients may be impaired. Genetic, autoimmunity, and environmental factors are all thought to play a role in the etiology of the disease. An interaction between the disease and the locus of human leukocyte antigen (HLA) on chromosome 6p21, protein tyrosine phosphatase non- receptor type 22 (PTPN22), and anti-cyclic citrullinated peptide (anti-CCP) antibodies is shown. Autoimmunity has gained in importance since the existence of the autoantibodies for the antigenic areas on the Fc part of the human immunoglobulin (Ig) G molecules. The need for orthopedic surgery has recently decreased with the help of both nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs) that are used in the treatment. Thirty percent of RA patients need major joint replacement surgeries such as hip and knees. Joint reconstruction, joint fusion, repair of tendon rupture, and tenosynovectomy are the reliable and effective options. When a surgical intervention is needed simultaneously, perioperative precautions have gained in importance because of the drugs that are still being used. Special preferences exist in terms of the appropriate surgical procedure, features of the implant, and sequence of the orthopedic surgical procedures.