The Hospital for Special Surgery Rheumatoid Arthritis Handbook

289 Pages·2001·1.54 MB·English

by  Stephen A. Paget

The Hospital
for Special Surgery
Rheumatoid Arthritis
z
Handbook
STEPHEN A. PAGET, M.D.,
MICHAEL D. LOCKSHIN, M.D.,
AND SUZANNE LOEBL
John Wiley & Sons, Inc.
D
edicated to the memory of Emmanuel Rudd, M.D.
St. Petersburg, 1914 — New York, 1995
Who spent his professional life
at the Hospital for Special Surgery,
a friend of every arthritis patient
fortunate enough to cross his path...
and for David always
Copyright © 2002 by The Hospital for Special Surgery. All rights reserved
Published by John Wiley & Sons, Inc.
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This title is also available in print as ISBN 0-471-41045-4. Some content that may appear
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Contents
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Acknowledgments v
Introduction 1
1 The Empowered Patient 5
2 Your Doctor, Your Partner 18
3 What Is Rheumatoid Arthritis? 31
4 How Rheumatoid Arthritis Affects
the Body 39
5 RA Immunity and Inflammation 49
6 Drugs, Drugs, and More Drugs 63
7 Aspirin, Other Nonsteroidal Anti-
Inflammatory Drugs, Super-Aspirins,
and Other Analgesics 69
8 Disease-Modifying Antirheumatic Drugs
(DMARDS) 81
9 Corticosteroids 96
10 Pregnancy and RA 107
11 Nutrition and RA 113
12 Exercise, Physical Therapy, and RA 131
13 Occupational Therapy and RA of
the Hands 150
iii
iv ◆ Contents
14 Coping with Rheumatoid Arthritis 163
15 Jeremiah J. Walsh: A Link Between RA’s
Past, Present, and Future 183
16 Surgery and RA 190
17 Surgery of the Knee 211
18 Surgery of the Hip 228
19 The Upper Extremities and the Feet 250
Appendix A: Questions and Answers
About RA 264
Appendix B: Glossary 274
Index 278
Acknowledgments
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The Hospital for Special Surgery Rheumatoid Arthritis Handbookreflects
the skill and knowledge of many experts. Special thanks are due to key
staff members as follows, in alphabetical order:
Adina Batterman, CSW, program coordinator for the HSS Rheumatoid
Arthritis Education and Support Group (Chapter 14)
Laura Broach, PT (Chapter 19)
Todd Cronin, PT, who is an expert at getting people with arthritis moving
(Chapter 12)
Glen Garrison, CPO, Cped, Director (Chapter 19)
Suzanne Graziano, RN, MS, ONC, CAN, clinical nurse specialist, Depart-
ment of Nursing Administration (Chapters 16, 17, and 18)
Annabel Griffith, OTR (Chapters 13 and 19)
Roberta Horton, ACSW, Program and Research Coordinator, HSS Depart-
ment of Patient Care (Chapter 14)
Bryan Nestor, M.D., assistant attending orthopaedic surgeon (Chapters 17
and 18)
Thomas P. Sculco, M.D., director of orthopaedic surgery and chief of the
Surgical Arthritis Service (Chapter 16)
Medical self-help books draw on works written by others. The
authors consulted numerous textbooks, journals, scientific reports, and
patient education publications, and attended relevant scientific meetings.
v
vi ◆ Acknowledgments
Specific thanks are due to the Arthritis Foundation for their excellent
publications and to the American College of Rheumatology and the Asso-
ciation for Rheumatology Health Professionals for their Primer on
Rheumatic Diseases and their excellent scientific meetings. Particular
thanks are due to Marian A. Minor, Ph.D., PT, for providing information
on how patients with rheumatoid arthritis can exercise.
This handbook is richly illustrated. Thanks are due to Lippincott,
Williams & Wilkins for permission to use the exercises presented in Chap-
ter 12, published in The Manual of Rheumatology and Outpatient Ortho-
pedic Disorders, by Stephen Paget, Paul Pellicci, and John F. Beary.
Exercises provided in the chapters dealing with total hip and knee
replacement, as well as other illustrations related to surgery and the pro-
tection of newly implanted joints, are provided courtesy of Suzanne
Graziano, Department of Nursing Administration, Hospital for Special
Surgery. The anatomical drawings are from the Columbia-Presbyterian
Osteoarthritis Handbook, edited by Ronald P. Grelsamer and Suzanne
Loebl, and are courtesy of Hungry Mind Publishers. We also want to
thank Amgen, Inc. for the drawing of an inflamed joint; Wright Medical
Technology, Arlington, TN, for the photographs of the total knee, total
hip, and Swanson finger joint implants; Dr. Alfred R. Swanson for the
photographs of the hands before and after surgery; Annabel Griffith for
the photograph of the dynamic hand splint; and Glenn Garrison for the
foot exercises. Thanks are due to the staff of HSS operating rooms, who
provided information when necessary as the authors watched the actual
joint replacement surgery, and Suzanne Graziano, who checked the sur-
gery chapters for accuracy.
The authors appreciate the help of their colleagues. Any mistaken
interpretation, however, is solely their responsibility.
We want to thank Chip Rossetti, our editor at Wiley, for shepherd-
ing this book through its editing and production process.
To be effective, self-help books rely on relating actual experiences.
An immense debt of gratitude is owed to the patients who shared their
experiences with the authors. Their names have been changed, but their
actual words and feelings are used throughout the book.
Introduction
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WHO SHOULD READ THIS BOOK
This book is written for people who suffer from rheumatoid arthritis as
well as for their families and friends. Rheumatoid arthritis (RA) is a
chronic disease for which self-care is crucial. The more you know about
the disease, the better you will be able to cope with it. However, in no
way can your knowledge substitute for the care provided by your physi-
cian and other members of your health team. This handbook’s purpose
is to amplify and reinforce their instructions and help you participate
more fully in your treatment.
WHY THIS BOOK
For a very long time, rheumatoid arthritis was a mystery. Paradoxically,
its symptoms are characteristic of arthritis, a disorder most commonly
seen among the elderly—yet, in this case, they occur in the young and
vigorous. It is a disorder associated with pain, weight loss, and eventu-
ally joint deformity. It is a malady that resembles an infection, yet for
years it yielded no identifiable “bug.” Gradually, the mystery and help-
lessness lifted. About 150 years ago, it was shown that a new drug,
aspirin—whose discovery itself was based on a folk remedy—offered
1
2 ◆ The Hospital for Special Surgery Rheumatoid Arthritis Handbook
temporary relief. Another drug—gold—was stumbled upon during the
1920s. At long last, on the eve of World War II, scientists realized that
rheumatoid arthritis was associated with a malfunction of the immune
system. Researchers were finally on the right track. The immune system,
however, was a mystery of its own, and even today its function is still
being unraveled. Fortunately, enough is known to make your rheuma-
toid arthritis treatable.
It is absolutely essential to minimize the damage that rheumatoid
arthritis can inflict on your body, but keeping the disease in check can
be a major undertaking. Helping you to do so is the lifework of the
authors of this book.
HOW THIS BOOK IS ORGANIZED
Chapters 1 through 5 explore the physiological processes that malfunc-
tion due to RA and the manner in which these irregularities affect the
body. Readers learn about joints, body mechanics, and the immune sys-
tem, and become familiar with the language used to describe various
aspects of the disease, its diagnosis, and treatment.
Chapters 6 through 9 are devoted to drug therapy, one of the prin-
cipal avenues for better treatment. In addition to general information
about medication, the chapters review the different classes of drugs used
to treat RA—analgesics, anti-inflammatory agents, immunosuppressants,
and corticosteroids—and explore their similarities and differences. Spe-
cial sections deal with questions you need to ask about newly prescribed
drugs: potential side effects, how long to take a specific medication, why
it works, and other details.
Chapter 10 explores specific considerations of having a baby when
suffering from RA.
Chapters 11, 12, and 13 review nondrug aspects of treatment: nutri-
tion and physical and occupational therapy. Sound nutrition plays a role
in the well-being of people suffering from rheumatoid arthritis. Certain
drugs, especially corticosteroids, have a major impact on metabolism and
body weight and may require a modification of your food intake. Chap-
ter 11 makes specific suggestions on how to handle some of these issues,
and also discusses vitamins and popular supplements such as glu-
cosamine and evening primrose oil. Chapter 12 reviews both recreational
and therapeutic exercises. Specific exercises designed to keep the body
limber and in good shape are suggested. Dysfunctional joints, especially
those of the hands, may make activities of daily living (performing rou-
Introduction ◆ 3
tine tasks) difficult. Chapter 13 outlines how to minimize and/or solve
these problems, and how to rehabilitate small joints.
In Chapter 14 we meet a group of patients with RA and explore the
psychological impact of this chronic disease. Courage and self-reliance are
as much a hallmark of those affected by RA as rheumatoid factor or genetic
predisposition. We explore ways of coping with difficult aspects of RA,
especially the unpredictability of the disease. Strategies are offered on how
to manage your sex life and on how to deal with depression and pain.
Remarkable Jerry Walsh is the subject of Chapter 15. He developed
the disease at age 18. Eventually, he became a patient at the Mayo Clinic
in Rochester, Minnesota, and was able to profit from the remarkable
advances in the treatment of RA that occurred during the second half of
the 20th century. Jerry was at Mayo soon after the discovery of the almost
miraculous effects of the corticosteroids and walked out of the hospital
with the assistance of two crutches. Toward the end of his life, he under-
went a double hip replacement at the Mayo Clinic. Jerry’s courage and
determination are an inspiration to all suffering from chronic disease.
Chapters 16 through 19 explore the surgical options available to
patients suffering from RA. The very detailed information about com-
monly used surgical procedures may help you in the inevitable decision-
making process that precedes surgery. Knowing what to expect before,
during, and after the operation may lessen the anxiety that accompanies
all major medical interventions.
A glossary and a set of frequently asked questions and their answers
complete the book.
YOUR MEDICAL TEAM
Founded in 1899, the Hospital for Special Surgery (HSS) is one of the
nation’s oldest and best orthopedic hospitals. From early on, rheumatoid
arthritis has been one of its special concerns. The following experts, all
on the hospital staff, have provided information that may further your
understanding of rheumatoid arthritis and its management. The infor-
mation provided is designed to amplify your knowledge. At no time
should it replace the instructions provided by your physician or any other
member of your own health care provider.
Drs. Stephen Paget and Michael Lockshin provide general informa-
tion about RA, as well as about standard drug therapy. Both have devoted
their entire professional lives to the treatment of rheumatoid arthritis and
other autoimmune disorders. Todd Cronin, a physical therapist, is an