Surgery and Long-term Prognosis
Orthopaedic surgery such as joint replacement has offered relief from severely damaged joints, including alleviating constant pain, and enhancing mobility and function. Reconstructive hand surgery is used to straighten deformed fingers and seeks to restore their function. Individuals either in the second or third decade of RA who are severely disabled achieve particularly great success from surgical interventions in addition to oral medications. Two studies were performed by researchers at Hospital for Special Surgery, and disputes the perception that RA patients have worse outcomes after a total knee replacement than patients who undergo the operation for osteoarthritis. The second study demonstrates that RA patients who undergo a total hip replacement were as likely to have significant improvements in function and pain as patients with osteoarthritis (OA), even though they did not do as well.60 Lifestyle modifications along with physical therapy may assist in reducing the burden of disability. It is estimated a 25% further reduction in RA disability can occur in developed countries with proper treatment management being optimally utilized. Research studies have indicated using methotrexate may potentially reduce mortality.61 Orthopaedic surgery and oral medications may not be available in low-income countries, and steroid therapy is offered too freely and possibly used indiscriminately. In such regions, if medical advice and interventions were available, an estimated 40% reduction in RA disability could occur.47
According to the National Rheumatoid Arthritis Society in the UK, factors associated with higher mortality rates include: conditions of severe RA; involvement in organs other than synovial joints; co-morbidity conditions; hospitalization stay; and extensive damage observed on x-rays.62 Life-shortening effects from RA vary, with some studies indicating a lifespan reduction by five to ten years.62 RA patients suffer from a doubled risk for cardiovascular disease;63 independent from risk factors such as diabetes, alcohol abuse and elevated body mass index, blood pressure, and cholesterol. However, deaths from cardiovascular disease among people with rheumatoid arthritis are declining.63 It remains unknown why RA creates such risk; contributing factors have suggested the presence of chronic inflammation.64 The impact from inflammation should not be overlooked and especially when treating patients with impaired immune systems.