![]() The C1 vertebra moves forward on C2 because of destruction of the transverse ligament and there is a risk of spinal cord compression by the odontoid peg. Atlanto-axial subluxation:Īnterior (affecting up to 80% of patients with atlanto-axial subluxation). There are two main categories of cervical spine instability: atlanto-axial subluxation and subaxial subluxation. Acute subluxation may cause spinal cord compression and/or compression of the vertebral arteries leading to quadriparesis or sudden death. This can lead to atlanto-axial instability in about 25% of patients suffering from RA. The atlanto-axial joint is commonly affected in RA because of attenuation of the transverse ligament and erosion of the odontoid peg. The following features are of relevance to anaesthesia. Extra-articular manifestations occur in >50% of patients overall those particularly relevant to anaesthesia involve the cardiovascular system, lungs, skin, eyes, bone marrow, kidneys and nerves ( Table 1). Commonly affected joints include the wrists, fingers, neck, shoulders, elbows, hips, knees, ankles and feet. Repeated episodes lead to progressive joint damage and severe disability in 10% of patients. Severe symptoms tend to occur in episodes lasting weeks or months, between which patients may be relatively asymptomatic. The predominant signs are soft tissue swelling, warmth, tenderness on pressure or movement, limitation of movement, deformities and nodules. Clinical features General featuresĬlinical features include a symmetrical pattern of joint pain (worst in the morning, improving with activity), morning stiffness, fatigue, weight loss, general malaise, depression and disability. Other risk factors associated with the development of RA include female gender, a family history of RA, food allergies and intolerances, altered gut flora, psychological stress, exposure to heavy metals and cigarette smoking. Environmental factors also seem to play a role, including as yet unidentified viral or bacterial agents. Approximately 70% of cases are associated with the HLA-DR4 subtype, and 80% of patients are seropositive for Rheumatoid factor. The initiating cause of RA remains unknown, but several factors may contribute. It is three times more common in women than men with a peak onset between 30 and 55 yr. RA affects about 1–2% of the UK population. This article will focus on adult patients with RA presenting for anaesthesia and surgery. 2 Still's disease is the commonest type of juvenile chronic arthritis affecting children. 1 RA is now known to be a chronic systemic inflammatory disorder characterized by deforming symmetrical polyarthritis of varying extent and severity, associated with synovitis of joint and tendon sheaths, articular cartilage loss and erosion of juxta-articular bone. However, the first description of rheumatoid arthritis in the medical literature is generally accorded to Augustin Jacob Landré-Beauvais in 1800 who described rheumatoid arthritis (RA) as ‘asthenic gout’ which exhibits several distinctive features, including predominance in women, a chronic course, involvement of many joints from the onset and a decline in general health. at that time ‘gout’ was used to describe all types of arthritis. ![]() Hippocrates mentioned joint ailments in his medical treatises around 400 yr B.C. ![]() Regional anaesthesia should always be considered as an alternative to general anaesthesia. Rheumatoid arthritis affects 1–2% of the UK population it is a chronic systemic inflammatory disorder.Ī thorough preoperative assessment including history and physical examination is essential to assess the extent and severity of the disease.Īirway and neck assessment is crucial atlanto-axial subluxation may be present and there is a potential risk of spinal cord damage.Īwake fibreoptic intubation may be required for airway management. ![]()
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