OBJECTIVE: To investigate the long-term efficacy of rehabilitation following arthroscopic synovectomy in patients with rheumatoid arthritis treated with biologic agents. METHODS: Arthroscopic synovectomy was performed in 29 joints of 17 patients, which were divided into two groups. Group 1 included arthroscopic synovectomy plus rehabilitation for 19 joints in 10 patients, and group 2 included arthroscopic synovectomy without rehabilitation for 10 joints in 7 patients. The Disease Activity Score C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Functional Independence Measure (FIM) values (motor subscale) at 9.7 years after arthroscopic synovectomy were evaluated to identify the clinical factors related to outcomes. RESULTS: The increase in FIM score was significant in group 1 (p=0.05). HAQ-DI at 9 years was significantly decreased in group 1 (p=0.02). Therefore, arthroscopic synovectomy with rehabilitation was significant in improving FIM and HAQ-DI scores over a long period. Multiple regression analysis of FIM scores at 9 years indicated that rehabilitation (p=0.03) and disease duration (p=0.02) were significantly related to outcomes. FIM score at 9 years was significantly negatively correlated with disease duration (p=0.01, r=−0.58, Y=88.89–0.21X). CONCLUSION: Rehabilitation following arthroscopic synovectomy was effective in achieving high FIM scores over time in patients with rheumatoid arthritis.
Arthritis, Rheumatoid* ; Biological Factors* ; C-Reactive Protein ; Humans ; Joints ; Rehabilitation*

PURPOSE: This study was performed to verify the effect of Tai Chi exercise on patients with rheumatoid arthritis particularly their level of pain, fatigue, sense of balance and daily life performance (ADL). METHOD: It employed a non-equivalent control group pre- and post-test design. The research instruments used in this study were pain, fatigue, sense of balance and ADL. Thirty-two patients in the experimental group carried out 50 minutes of Tai Chi exercise for 12 weeks, and 29 patients in the control group did not. Before and after the experiment, both groups were tested for pain, fatigue, sense of balance and ADL. Collected data were processed using the SPSS/WIN 10.0 program analyzed by the frequency, percentage, X2-test, and t-test. RESULTS: Pain and fatigue significantly decreased in the experimental group. However the improvement in ADL of the rheumatoid arthritis patients was not statistically significant but their sense of balance was enhanced significantly. CONCLUSION: Tai Chi exercise is an effective nursing intervention that can be used for rheumatoid arthritis patients.
Activities of Daily Living ; Arthritis, Rheumatoid/*rehabilitation ; Fatigue/*rehabilitation ; Female ; Humans ; Male ; Middle Aged ; Pain/*rehabilitation ; Postural Balance ; *Tai Ji

OBJECTIVE: To evaluate the effect of functional exercises on disease activity, joint function and quality of life of patients with rheumatoid arthritis (RA). METHODS: Randomized controlled trials were searched in Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), VIP database and Wanfang database with keywords being "rheumatoid arthritis/RA", "function exercise (training)/joint exercise (training)/physical exercise (training)/resistance movement (exercise)/isotonic and isometric/stretching exercise/muscle exercise", and "trials/clinical trials". Then literature selection, extraction and literature quality evaluation were carried out by two of the authors independently following the including and excluding standards. Then the outcome indicators were analyzed with Review Manager 5.3 software. RESULTS: In the study, 2 173 articles were achieved by searching in databases, including 1 522 English papers and 651 Chinese papers. Then 913 duplicated papers were identified and removed using EndNote software. After reading the titles and abstracts, 1 194 papers were excluded that did not satisfy the including standards. Finally, the full texts of these papers were read and papers with insufficient data were excluded, resulting in 13 included papers for systematic review, including 8 English and 5 Chinese papers. A total of 812 cases were studied in these papers, including 426 in the experimental groups and 386 in the conventional groups. For the outcome index in these articles, disease activity score 28 (DAS28) was used in 5 of them, health assessment questionnaire (HAQ) was used in 8 articles, visual analogue scale (VAS) for pain was used in 6 articles, and morning stiffness duration was used in 3 articles. The meta-analysis showed that functional exercises could delay the development of the disease activity of RA patients (mean difference=-0.76; 95%CI: -1.13, -0.38; P<0.001), improve the joint function (mean difference=-0.36; 95%CI: -0.47, -0.24; P<0.001), alleviate the pain of joints (mean difference=-1.75; 95%CI: -1.98, -1.53; P<0.001), and reduce the duration of morning stiffness (mean difference=-17.65; 95%CI: -22.09, -13.21; P<0.001). CONCLUSION This study showed the positive effects of functional exercises on alleviating the pain of joints, reducing the morning stiffness duration, and delaying the disease exacerbation of RA patients. It has a positive effect on improving the joint function and improving the quality of life in patients with RA.
Arthritis, Rheumatoid/rehabilitation* ; Exercise ; Exercise Therapy ; Humans ; Pain Management ; Quality of Life

Excessive teeth wear may result in the complications such as esthetic problems, hypersensitivity, and loss of vertical dimension. This clinical report focuses on the causes of severely worn dentition and the full-mouth rehabilitation of a patient with rheumatoid arthritis for 20 years. An interview, clinical and radiological examinations were performed to analyze the causes and decide the treatment plan. After delivery of the final prostheses, a night guard was used to protect the restorations and temporomandibular joints. The patient was satisfied esthetically and functionally.
Arthritis, Rheumatoid ; Dentition* ; Humans ; Hypersensitivity ; Mouth Rehabilitation* ; Mouth* ; Prostheses and Implants ; Rehabilitation ; Temporomandibular Joint ; Tooth ; Tooth Wear ; Vertical Dimension*

Total knee arthroplasty is indicated for painful joints, with or without deformity, secondary to rheumatoid arthritis, osteoarthritis, traumatic arthritis, and certain other forms of nonseptic arthropathy. Many patients with arthritic knees have symetrical involvement and thus require a bilateral operation. Staged bilateral arthroplastis were performed with many drawbacks such as prolonged hospitalization, repeated anesthetic risks, and increased cost. Simultaneous bilateral arthroplasty under one anesthesia by two teams offers several advantages over staged procedure. We studied the results of 145 total knee arthroplasties, performed over a five-year period, to compare unilateral(group I;45 knees), staged bilateral(group II; 24 knees), and simultaneous bilateral arthroplasties(group III; 76 knees) by 2 team approach. Duration of mean follow-up was 1 year and 9 months. The results are as flollows; 1. The mean anesthetic times were 189 minutes, 312 minutes, and 218 minutes for the group I,II,III, respectively. 2. The mean blood loss was 1075ml for the group I, 1644ml for the group II, and 1902ml for the group III. 3. The hospitalization period was 74.1 days in two stage procedures, while it was 48.6 days in simultaneous bilateral procedures. 4. Knee scores by Knee Rating Scale of Hospital for Special Surgery were increased to 85.3 points, 80.7 points, and 85.4 points for group I,II,III, respectively. 5. There were no difference in complication among three groups. 6. Group III had advantages such as reduced anesthetic risk, reduced rehabilitation period, and decreased cost.
Anesthesia ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Follow-Up Studies ; Hospitalization ; Humans ; Joints ; Knee ; Osteoarthritis ; Rehabilitation

The purpose of this study was to determine the factors which were responsible for delaying early diagnosis and optimal management of rheumatoid arthritis (RA) in Korea. We interviewed 109 outpatients diagnosed as RA being treated by rheumatologists, and we eventually analyzed 98 patients' data. The median length of time from symptom onset to the first visit to a medical doctor, to diagnosis, and visiting a rheumatologist were 8 weeks, 23 weeks, and 42 months respectively. The subspecialist with whom the patients consulted with for the longest time before visiting a rheumatologist were an orthopaedic surgeon for 51 patients, a Chinese herbal doctor for 19 patients, and a pharmacist for 16 patients. For early diagnosis and optimal management of RA in Korea, we believe that it is necessary to reduce the use of unconventional medical services such as Chinese herbal medicine and nonprescribed medication, and to emphasize rheumatologic and rehabilitative care in the early stage.
Adult ; Alternative Medicine/utilization ; Arthritis, Rheumatoid/therapy* ; Arthritis, Rheumatoid/rehabilitation ; Female ; Health Services/utilization* ; Human ; Korea ; Male ; Middle Age ; Rheumatology/methods

A follow-up study was made of 26 knees of 21 patients who underwent arthroscopic synovectomy between October 1982 and August 1983 in Catholic Medical College and Center. The patient's ages ranged from 3 to 66 years of age. There were 14 female patients and 7 male patients in this series. The follow-up period of all patients was a minimum of twelve months to a maximum of 20 months. The average follow-up of the whole group was 16.8 months. The abnormal findings were rated from 0 to 4 according to Marmors rating system. Final clinical evaluations of the patients were done according to the modified criteria of Sledge et al. The results were as follows; 1. Rheumatoid Arthritis Of 14 knees, 3 joints(21.4%) were rated “excellent”, 6(42.9%) were “good”, and 5(35.7%) were “fair”. There was no case of “unimproved”. 2. Juvenile Rheumatoid Arthritis The results of all 5 knees were satisfactory. Of 5 knees, 4 joints(80%) were rated excellent and one joint (20%) was good. 3. There were 3 knees of osteoarthritis, 3 knees of chronic synovitis and one knee of pigmented villonodular synovitis. Their final results were all satisfactory. Three joints were rated excellent and the other 3 joints were good. 4. Of 26 knees, as a whole, 10 joints (38.5%) were rated “excellent”, 11 joints (42.3%) were “good”, 5 joints (19.2%) were “fair” and no joint was “unimproved”. There were 5 recurrences of active synovial disease in this series, and these patients all were “classic” rheumatoid arthritis. But surprisingly the average patient in this group of recurrence did well even after recurrence. These patients all had less pain and effusion than before operation. 5. The major cause of unsatisfactory results other than recurrence of synovitis were articular degeneration (joint space narrowing) and patellofemoral osteoarthritis (4 knees). 6. A good range of motion with the shortest rehabilitation period can be expected if alternate flexion and extension splints are applied on alternate days for less than a week following the surgery. In conclusion, one may state that the arthroscopic synovectomy is worth considering for the treatment of various kinds of synovitis of the knee joint and when the rheumatoid process follows a favourahle course.
Arthritis, Juvenile ; Arthritis, Rheumatoid ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee ; Male ; Osteoarthritis ; Range of Motion, Articular ; Recurrence ; Rehabilitation ; Splints ; Synovitis ; Synovitis, Pigmented Villonodular

A large number of patients who are diagnosed with rheumatoid arthritis undergo a chronic and progressive course. Surgical treatment is often needed for these patients, who have not responded to medical treatment. The aim of surgical intervention in rheumatoid arthritis is to restore function and quality of life by preventing joint destruction, correcting deformity, relieving pain, and making cosmetic improvements. There are many surgical options, including synovectomy, osteotomy, arthrodesis, resection arthroplasty, joint replacement, surgeries for the treatment of the tendon involved (repair, transfer, graft), and cervical spine surgery (fusion or decompression). The selection of the optimal surgical option requires consideration of not only the articular status and the degree of regional deformity involved, but also the physical status and age of the patient. In addition, timely surgical intervention is important because a delay of surgery often results in poorer functional outcomes and an increase in postoperative complications. Early referral to orthopedic treatment can provide better functional outcomes for patients with rheumatoid arthritis. Precise prediction of the disease progress and selection of the optimal treatment option are needed for excellent results to be expected. Therefore, a cooperative and multidisciplinary treatment strategy should be made among the relevant teams, such as physical medicine, rheumatology, orthopedics, physical therapy, occupational therapy, social work, and psychology.
Arthritis, Rheumatoid ; Arthrodesis ; Arthroplasty ; Congenital Abnormalities ; Cosmetics ; Humans ; Joints ; Occupational Therapy ; Orthopedics ; Osteotomy ; Physical and Rehabilitation Medicine ; Postoperative Complications ; Quality of Life ; Referral and Consultation ; Rheumatology ; Social Work ; Spine ; Tendons

The origin of the popliteal cyst is the popliteal bursa and frequently combined with the intraarticular lesion. And open excision has been commonly used as a treatment. The authors reviewed 39 cases of popliteal cyst in 38 patients, mangaged with arthroscopic method at Department of Orthopedic Surgery, College of Medicine, Korea University Hospital from June 1989 to July 1993 and the following results were obtained. l. Among 39 cases, 35 cases(89.7%) were associated with intraarticular lesions of the knee joint; 25 cases(71.4%) were chondral injuries, 6 cases(17.1%) were meniscus tear, 2 cases(5.7%) were rheumatoid arthritis and 2 cases were plica syndrome. 2. 20 cases(51.2%) were shown to have the communication between cyst and joint. 3. During operation, position change of the patient and another draping was not necessary. And the blue stained wall enabled authors to remove more completely the popliteal cyst than other conventional operative procedures. 4. Becuase of the short skin incision, the operation time was saved and we were able to recommend early excercise of the knee joint and ambulation. The operative treatment of popliteal cyst with the arthroscopy is the one staged method to excise the cyst and to intervent the combined intraarticular pathology which develop the cyst, and is one of the recommendable method bacause of small skin incision, short hospitalization and early rehabilitation.
Arthritis, Rheumatoid ; Arthroscopy ; Hospitalization ; Humans ; Joints ; Knee Joint ; Korea ; Methods ; Orthopedics ; Pathology ; Popliteal Cyst ; Rehabilitation ; Skin ; Surgical Procedures, Operative ; Tears ; Walking

Spontaneous extensor pollicis longus tendon rupture is commonly caused by attrition of the tendon from trauma or inflammatory processes. We experienced a patient with extensor pollicis longus tendon rupture after steroid injection, in which the rupture may have been caused by the effects of steroid itself as well as direct damage from the needle. A 51-year-old woman complained of inability to extend her right thumb at the first metacarpophalangal & interphalangeal joint level. The patient had a history of local steroid injection into the dorsal & radial side of wrist on two occations, and had no history of trauma or rheumatologic disease. After a physical examination of the patient, we decided to explore the wrist. The patient agreed with operation. Intraoperatively, an incision was made into the wrist and the proximal and distal ends of the ruptured extensor pollicis longus tendon were identified. The defect between the proximal and the distal end was measured to approach 8cm, and a palmaris longus tendon graft was performed. After three months of rehabilitation, the first metacarpophalangal & interphalangeal joint recovered the normal range of motion. Steroid injection has been widely used in various musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis. However, inadvertent steroid injection into the extra or intra articular spaces may lead to tendon rupture. Steroids reduce tensile strength by decreasing tenocyte activity and collagen synthesis. Also, the physical effect of direct needle-stick injury into the mesotenon and blood vessels around the tendon may cause damage. In addition, hematoma and edema may increase pressure around the tendon and compromise blood supply, leading to tendon degeneration and subsequent rupture. When injecting steroid into an articular area, all physicians should have a complete understanding of the surrounding anatomy and always keep in mind the hazards of such procedures.
Arthritis, Rheumatoid ; Blood Vessels ; Collagen ; Edema ; Female ; Hematoma ; Humans ; Joints ; Middle Aged ; Needles ; Needlestick Injuries ; Osteoarthritis ; Physical Examination ; Reference Values ; Rehabilitation ; Rupture* ; Steroids ; Tendons* ; Tensile Strength ; Thumb ; Transplants ; Wrist