Distal Rheumatoid Arthritis

It is an antisecretory drug. It is 5-ami-nosalicylic acid with linked sulfapyridine through azo bond. The drug is poorly absorbed from the intestine and the azo linkage is broken down by the bacterial flora in the distal ileum and colon to release 5-ami-nosalicylic acid (5-ASA) and sulfapyridine. 5-ASA inhibits locally prostaglandin synthesis, decreases mucosal secretion. It is used in rheumatoid arthritis and ulcerative colitis. Side effects include fever, rashes, blood dyscrasias, nausea, vomiting and headache. 

Vasculitis usually is seen in patients with long-standing rheumatoid arthritis. Vasculitis may result in a wide variety of clinical presentations. Invasion of blood vessel walls by inflammatory cells results in an obliteration of the vessel, producing infarction of tissue distal to the area of involvement. Most commonly, small-vessel vasculitis produces infarcts near the ends of the fingers or toes, especially around the nail beds. These infarcts are usually of little consequence. 

The monoclonal antibody rituximab, which binds to CD20, has been approved by FDA for the treatment of non-Hodgkin lymphoma and rheumatoid arthritis. After binding to CD20-positive cells, the exposed distal Fc part of the antibody leads to subsequent complement activation, antibody-dependent cell-mediated cytotoxicity, activation of natural killer cells, and finally cell lysis... 

Elbow is one of the most complex articular anatomy of human joint. Distal humerus, Proximal radius, and Proximal ulna are three elbow joint bones which are connected by tendons, ligaments and muscles [1]. Most famous disease that can affect normal elbow s function is rheumatoid arthritis that weaken the function status of patient. Total elbow arthroplasty can be the best decision for those patients that has advance elbow dysfunction, regarding to relive the pain and restore the normal physiological function [2]. Like all other joint replacement some complication such as instability, loosening, dislocation, polyethylene wear and infection, has restricted the long term survivorship of Total elbow arthroplasty [3]. 

Arthroplasty is one of the treatments for severe deformity case of Rheumatoid Arthritis, intended to preserve wrist joint motion while removing pain or any other problems associated with the wrist joint [6]. However, there are several problems associated with the wrist arthroplasty. Loosening effect was commonly occurred due to lack of bony support towards the implant [7-8]. Jay Menon et al. claimed that the wrist arthroplasty experienced with a earpal component fixed with three screws could successfiilly result a good bony support [8]. Bone graft was needed in order to enhance the fusion between bones and implant [9]. Hence, the aim of this project was to analyse the biomechanical effect of bone graft in enhancing distal component fixation of the wrist implant. 

Fig. 8.71a,b. Synovitis of the elbow joint pitfall. a,b Transverse 12-5 MHz US images over the posterior olecranon recess a in a normal subject and b in a patient with rheumatoid arthritis and an olecranon recess (arrows) appears markedly distended by fluid. In a, the normal hypoechoic fat contained. In b the olecranon fossa, between the lateral (LE) and medial (ME) epicondyles, should not be confused with the synovitis process shown in b. In doubtful cases, careful dynamic examination with elbow flexion and extension movements may be helpful for the diagnosis. Note the erosion (arrowhead) on the posteromedial aspect of the lateral epicondyle. T, distal triceps tendon... 

Fig. 10.41 a,b. Hypertrophic tenosynovitis of the extensor carpi ulnaris in a patient with rheumatoid arthritis, a Short-axis and b long-axis 12-5 MHz US images of the extensor carpi ulnaris tendon (ecu) reveal hypoechoic synovial pannus (arrowheads) which causes abnormal distention of the synovial sheath. The extensor carpi ulnaris is displaced anteriorly because of loosening of the retinaculum. Note the pannus filling the distal radioulnar joint cavity (arrow)... 

Fig. 10.71. Caput ulnae syndrome in rheumatoid arthritis. Schematic drawing of a transverse view through the distal radioulnar joint outlines the rupture of the triangular fibrocartilage (arrowheads) and marginal erosions at the distal radio-ulnar joint level due to intra-articular pannus (asterisks). As a result, the ulna subluxes dorsally (gray arrow). Pannus (star) inside the extensor carpi ulnaris tendon (open arrow) sheath leads to cortical erosions, tear of the retinaculum and tendon thinning and splitting. St, styloid of the ulna Rad, radius...

Fig. 10.72a,b. Caput ulnae syndrome in rheumatoid arthritis, a Longitudinal and b transverse 12-5 MHz US images over the extensor carpi ulnaris tendon (straight arrows) reveal synovial pannus inside the distal radio-ulnar joint (asterisk) and the extensor carpi ulnaris tendon sheath (arrowheads). The tendon is dislocated (curved arrow) out of its ulnar groove due to the tear of the retinaculum. See Fig. 10.20b for comparison with normal findings... 

Fig. 11.38a,b. Complete tear of the flexor pollicis longus tendon in a patient with severe rheumatoid arthritis, a Longitudinal 12-5 MHz US image over the thenar compartment displays the distal end (arrowheads) of the ruptured flexor pollicis longus (arrows), which appears irregular and diffusely hypoechoic with loss of the fibrillar echoes. Observe the posterior acoustic shadowing (asterisks) related to sound-beam refraction, b Contralateral normal tendon (arrows)... 

Fig. 14.94a,b. Baker cyst anomalous caudal extension. Patient with longstanding rheumatoid arthritis, a Longitudinal 12-5 MHz US image over the proximal medial leg with b schematic drawing correlation reveals a large base of the cyst (asterisk) extending distally between the medial head of the gastrocnemius (MHG) and the deep soleus muscle (S)... 

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