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Perioperative management of patient with late rheumatoid arthritis and post-bone tuberculosis with genu contracture undergoing tenotomy

  • Asri Insanur Rahma ,
  • Awalia ,


Abstract

Background: Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease that potentially attacks all parts of the human body. Despite the use of disease-modifying anti-rheumatic drugs (DMARDs), the rate of total knee arthroplasty (TKA) remains high. Critical complications such as infection, dislocation, and readmission following TKA are also reportedly high and therefore, appropriate management during perioperative period is critical. We reported the perioperative management of a patient with late RA and genu contracture underwent tenotomy.

Case Presentation: A 22-year-old male was referred to Dr. Soetomo General Hospital with a chief complaint of pain in the right and left groin. He also complained of immobilization and stiffness in both knees. He had been diagnosed with bone tuberculosis in 2014 and underwent a total knee replacement of both knees in 2015 due to stiffness and inability to walk. Radiography examination indicated erosion and loss of joint spaces in the joints of the hip, fingers, and toes. Laboratory investigation showed positive anti-mutated citrullinated vimentin (anti-MCV), confirming RA. The patient underwent tenotomy surgery and was treated with methylprednisolone 4 mg peroral daily, chloroquine 250 mg peroral daily, and natrium diclofenac peroral to reduce pain. Tenotomy was performed. Considering the disease activity, conventional DMARDs (chloroquine 250 mg peroral and low dose steroid, methylprednisolone 1x4mg peroral) were prescribed.

Conclusion: The case highlights the complexity of perioperative management of late RA and genu contracture underwent tenotomy that required multiple disciplines. Therefore, interdisciplinary collaborative team is critical to be able to achieve optimal results of the patient.

Keywords: Perioperative management rheumatoid arthritis genu contracture tenotomy

References

  1. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA. 2018;320(13):1360-1372. doi: 10.1001/jama.2018.13103.
  2. Sparks JA. Rheumatoid Arthritis. Ann Intern Med. 2019;170(1):ITC1. Available from: http://dx.doi.org/10.7326/aitc201901010
  3. Tom S. Kelley and Firestein’s Textbook of Rheumatology, 2-volume Set, 10th Edition. J Rheumatol. 2017;44(6):964. Available from: http://dx.doi.org/10.3899/jrheum.170289
  4. Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. J Arthroplasty. 2017;32(9):2628–38. Available from: http://dx.doi.org/10.1016/j.arth.2017.05.001
  5. Sommer OJ, Kladosek A, Weiler V, Czembirek H, Boeck M, Stiskal M. Rheumatoid Arthritis: A Practical Guide to State-of-the-Art Imaging, Image Interpretation, and Clinical Implications. RadioGraphics. 2005;25(2):381–98. Available from: http://dx.doi.org/10.1148/rg.252045111
  6. Tarner I, Harle P, Mullerladner U, Gay R, Gay S. The different stages of synovitis: acute vs chronic, early vs late and non-erosive vs erosive. Best Pract & Res Clin Rheumatol. 2005;19(1):19–35. Available from: http://dx.doi.org/10.1016/j.berh.2004.08.002
  7. Singh JA, Saag KG, Bridges SL, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis & Rheumatol. 2015;68(1):1–26. Available from: http://dx.doi.org/10.1002/art.39480
  8. Scott DL. Pursuit of optimal outcomes in rheumatoid arthritis. Pharmacoeconomics. 2004;22(2 Suppl 1):13-26. doi: 10.2165/00019053-200422001-00003.
  9. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheum. 2010;62(9):2569–81. Available from: http://dx.doi.org/10.1002/art.27584
  10. Lee YH, Bae S-C, Song GG. Diagnostic accuracy of anti-MCV and anti-CCP antibodies in rheumatoid arthritis. Z Rheumatol. 2015;74(10):911–8. Available from: http://dx.doi.org/10.1007/s00393-015-1598-x
  11. Trieb K, Hofstaetter SG. Treatment strategies in surgery for rheumatoid arthritis. Eur J Radiol. 2009;71(2):204–10. Available from: http://dx.doi.org/10.1016/j.ejrad.2009.04.050
  12. Anderson J, Caplan L, Yazdany J, Robbins ML, Neogi T, Michaud K, et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken). 2012;64(5):640–7. Available from: https://pubmed.ncbi.nlm.nih.gov/22473918
  13. Smolen JS, Aletaha D. Monitoring disease activity in rheumatoid arthritis: an imperative. Fut Rheumatol. 2008;3(2):99–102. Available from: http://dx.doi.org/10.2217/17460816.3.2.99
  14. Rawla P. Cardiac and vascular complications in rheumatoid arthritis. Reumatologia. 2019/02/28. 2019;57(1):27–36. Available from: https://pubmed.ncbi.nlm.nih.gov/30858628
  15. Lee JK, Choi C-H. Total knee arthroplasty in rheumatoid arthritis. Knee Surg Relat Res. 2012/02/28. 2012;24(1):1–6. Available from: https://pubmed.ncbi.nlm.nih.gov/22570845

How to Cite

Rahma , A. I., & Awalia. (2022). Perioperative management of patient with late rheumatoid arthritis and post-bone tuberculosis with genu contracture undergoing tenotomy. Bali Medical Journal, 11(2), 913–917. https://doi.org/10.15562/bmj.v11i2.3443
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