Long-Term Functional Results of Wrist Arthrodesis in Rheumatoid Arthritis

1999 ◽  
Vol 24 (1) ◽  
pp. 27-31 ◽  
Author(s):  
O. BARBIER ◽  
P. SAELS ◽  
J. J. ROMBOUTS ◽  
J. L. THONNARD
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Functional Results ◽  
Upper Limbs ◽  
Wrist Arthrodesis ◽  
Significant Difference ◽  
Degree Of Satisfaction ◽  
Functional Capacities ◽  
High Degree

The purpose of this study was to evaluate the long-term effectiveness of wrist fusion on the relief of pain and also the functional capacities of the upper limbs in patients with rheumatoid arthritis (RA). Eighteen patients were assessed at a mean of 7 years after wrist arthrodesis and a mean of 17 years after the onset of RA. Radiological measurements, pain assessment and impairment rating of the upper limbs were made of the fused and non-fused sides. The average position of arthrodesis was 8° of extension and 9° of ulnar deviation. All patients were pleased with the procedure and had satisfactory pain relief. Impairment ratings did not detect any significant difference in the sensory and motor function of the hand when the fused and non-fused groups were compared. We conclude that in patients with rheumatoid arthritis, wrist arthrodesis is a reliable procedure that provides predictable pain relief and a high degree of satisfaction without additional functional loss in the upper limb.

Percutaneous glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis: a long-term retrospective cohort study

2020 ◽  
Vol 132 (5) ◽  
pp. 1405-1413 ◽  
Author(s):  
Michael D. Staudt ◽  
Holger Joswig ◽  
Gwynedd E. Pickett ◽  
Keith W. MacDougall ◽  
Andrew G. Parrent
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Retrospective Chart Review ◽  
Medication Usage ◽  
Free Response ◽  
Free Survival ◽  
Time To Recurrence ◽  
Significant Difference

OBJECTIVEThe prevalence of trigeminal neuralgia (TN) in patients with multiple sclerosis (MS-TN) is higher than in the general population (idiopathic TN [ITN]). Glycerol rhizotomy (GR) is a percutaneous lesioning surgery commonly performed for the treatment of medically refractory TN. While treatment for acute pain relief is excellent, long-term pain relief is poorer. The object of this study was to assess the efficacy of percutaneous retrogasserian GR for the treatment of MS-TN versus ITN.METHODSA retrospective chart review was performed, identifying 219 patients who had undergone 401 GR procedures from 1983 to 2018 at a single academic institution. All patients were diagnosed with medically refractory MS-TN (182 procedures) or ITN (219 procedures). The primary outcome measures of interest were immediate pain relief and time to pain recurrence following initial and repeat GR procedures. Secondary outcomes included medication usage and presence of periprocedural hypesthesia.RESULTSThe initial pain-free response rate was similar between groups (p = 0.726): MS-TN initial GR 89.6%; MS-TN repeat GR 91.9%; ITN initial GR 89.6%; ITN repeat GR 87.0%. The median time to recurrence after initial GR was similar between MS-TN (2.7 ± 1.3 years) and ITN (2.1 ± 0.6 years) patients (p = 0.87). However, there was a statistically significant difference in the time to recurrence after repeat GR between MS-TN (2.3 ± 0.5 years) and ITN patients (1.2 ± 0.2 years; p < 0.05). The presence of periprocedural hypesthesia was highly predictive of pain-free survival (p < 0.01).CONCLUSIONSPatients with MS-TN achieve meaningful pain relief following GR, with an efficacy comparable to that following GR in patients with ITN. Initial and subsequent GR procedures are equally efficacious.

SHORT TO MEDIUM RESULTS USING THE REMOTION TOTAL WRIST REPLACEMENT FOR RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 175-178 ◽  
Author(s):  
A. S. C. Bidwai ◽  
F. Cashin ◽  
A. Richards ◽  
D. J. Brown
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Surgical Intervention ◽  
Case Series ◽  
High Rate ◽  
Wound Breakdown ◽  
Radial Forearm ◽  
Skin Coverage

We present the clinical outcome of patients who underwent RE-MOTION Total Wrist Replacement (TWR) for the treatment of Rheumatoid arthritis involving the wrist. Ten patients were available for follow-up, ranging from one to five years after index surgery. Two patients required surgical intervention for wound breakdown, including one patient who required a radial forearm flap for skin coverage. No patients required revision surgery or conversion to fusion. Patients who did not have complications gained statistically significant pain relief and improvement in mean overall flexion. In this small case series with short to medium results patients reported an improvement in terms of flexion and pain. Despite this, the question of efficacy of TWR compared to fusion in the long term remains unanswered due to the high rate of complications.

scholarly journals Long-Term Outcome and Secondary Operations after Proximal Row Carpectomy or Four-Corner Arthrodesis

2017 ◽  
Vol 07 (01) ◽  
pp. 051-056 ◽  
Author(s):  
John Williams ◽  
Hadley Weiner ◽  
Andrew Tyser
Keyword(s):  
Smoking Status ◽  
Proximal Row Carpectomy ◽  
Long Term Outcome ◽  
Wrist Arthrodesis ◽  
Conversion Rates ◽  
Significant Difference ◽  
Patient Reported ◽  
Secondary Operations

Background Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common surgical procedures used to treat degenerative wrist conditions; however, complications and failures can occur. Purpose This study aimed to investigate and compare the long-term rate of secondary surgeries including conversion to total wrist arthrodesis in patients who underwent PRC or FCA. Materials and Methods A retrospective chart review of all patients who underwent PRC or FCA in the past 20 years at a tertiary referral institution and associated Veterans Affairs (VA) hospital was performed. Patient demographics, comorbidities, surgical indications, and associated complications were tabulated. Patients were contacted via phone to obtain additional follow-up information regarding any additional surgeries, 10-point visual analog scale (VAS) for pain, quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, hand dominance, and occupational data. Results A total of 123 wrists made up the final dataset. Sixty-two wrists treated with PRC and 61 wrists treated with FCA were reviewed at a mean follow-up of 8.2 years. We did not find a significant difference in the rate of conversion to total wrist arthrodesis between the PRC (14.5%) and FCA (19.5%, p = 0.51) cohorts. Secondary operations were significantly greater in the FCA group (34.4%) compared with the PRC group (16.1%, p = 0.02). Females were 2.6 times more likely than males to undergo secondary operations when controlling for surgical procedure and smoking status (p = 0.04). We did not detect a significant difference in VAS pain or in quickDASH scores between the two groups (p = 0.35, 0.48, respectively). Conclusion PRC and FCA have comparable patient reported outcomes and wrist arthrodesis conversion rates at a mean follow-up of 8.2 years. In contrast, the FCA patient group had a significantly higher rate of secondary operations, including those for nonunion, symptomatic hardware, and other implant-related issues, when combined with wrist arthrodesis conversion. Level of Evidence Level IV, therapeutic study.

scholarly journals Long-Term Results of a Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Refractory Neuropathic Pain

2017 ◽  
Vol 3 (1) ◽  
pp. 4-15
Author(s):  
Byung-chul Son ◽  
Jin-gyu Choi ◽  
Sang-woo Ha ◽  
Deog-ryeong Kim
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Motor Cortex ◽  
Success Rate ◽  
Rating Scale ◽  
Long Term Results ◽  
Motor Cortex Stimulation ◽  
Significant Difference ◽  
Deep Brain

Objective Although deep brain stimulation (DBS) and motor cortex stimulation (MCS) are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis (Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results Of the 11 patients implanted with both DBS and MCS electrodes, nine (81.8%) had successful trials. Seven of these nine patients (77.8%) responded to MCS, and two (18.2%) responded to Vc DBS. With long-term follow-up (56 ± 27.5 months), the mean numerical rating scale decreased significantly (P < 0.05). The degree of percentage pain relief in the chronic MCS (n = 7) and chronic DBS (n = 2) groups were 34.1% ± 18.2% and 37.5%, respectively, and there was no significant difference (P = 0.807). Five out of the seven MCS patients (71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.

Neurosurgical Choice for Glossopharyngeal Neuralgia: A Benefit–Harm Assessment of Long-Term Quality of Life

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 131-139 ◽  
Author(s):  
Tao Du ◽  
Bing Ni ◽  
Wei Shu ◽  
Yongsheng Hu ◽  
Hongwei Zhu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Brief Pain Inventory ◽  
Glossopharyngeal Neuralgia ◽  
Significant Difference ◽  
Patient Database ◽  
Global Impression Of Change ◽  
Satisfaction Rates

Abstract BACKGROUND Microvascular decompression (MVD) and vagoglossopharyngeal rhizotomy (VGR) are effective treatment for glossopharyngeal neuralgia (GN). However, surgical choice is controversial due to the need to maximize pain relief and reduce complications. OBJECTIVE To retrospectively compare safety, efficacy, long-term quality of life (QOL), and global impression of change following MVD and VGR for treatment of GN. METHODS Patient database reviews and telephone surveys were conducted to assess baseline characteristics and long-term outcomes. The effects of pain and complications on QOL were assessed using Brief Pain Inventory-Facial (BPI-Facial) questionnaire. Complication tolerance and surgery satisfaction were sorted using the global impression of change survey. RESULTS Of 87 patients with GN, 63 underwent MVD alone, 20 underwent VGR alone, and 4 underwent VGR following a failed MVD. The long-term rate of pain relief was slightly, but not significantly, lower following MVD than VGR (83.6% vs 91.7%, P = .528). However, long-term complications occurred much more frequently following VGR (3.0% vs 50.0%, P &lt; .001). The BPI-Facial, which evaluates pain and complications, showed that MVD had better postoperative QOL than VGR (P &lt; .001). However, 91.7% of patients who underwent VGR experienced no or mild complications. There was no significant difference in the overall satisfaction rates between the groups (83.3% vs 83.6%, P &gt; .99). CONCLUSION Although VGR resulted in lower postoperative QOL due to a high complication rate, most of these complications were mild. The overall satisfaction rates for the 2 surgeries were similar.

scholarly journals Universal 2 Wrist Arthroplasty in Rheumatoid Arthritis

2017 ◽  
Vol 06 (03) ◽  
pp. 206-215 ◽  
Author(s):  
Giovanni Munz ◽  
Giulia Guidi ◽  
Massimo Ceruso ◽  
Sandra Pfanner
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Grip Strength ◽  
Visual Analogue Scale Pain ◽  
Level Of Evidence ◽  
Flexion Extension ◽  
The Mean ◽  
Wrist Arthroplasty

Purpose The aim of this study was to evaluate the mid- to long-term outcomes and complications in patients affected by rheumatic diseases treated with the Universal 2 (U2) total wrist arthroplasty (TWA). Methods We reviewed, in a retrospective, noncontrolled cohort study, 22 patients affected by rheumatoid arthritis (RA), who underwent U2 total wrist replacement between March 2003 and January 2014 for the treatment of 23 rheumatoid wrists with the aim of obtaining the remission of pain and a range of motion (ROM) useful for daily activities, according to the patients' demands, as an alternative to total wrist arthrodesis. The cohort of patients included 20 females and 2 males, with a mean age of 54.9 years. Residual pain, preoperative ROM, postoperative ROM increases, grip strength, radiographic changes, long-term complications, and reasons for revision or failures were evaluated. Results In this study, 22 patients were evaluated at a mean follow-up of 82.3 months (range: 2–12 years). All patients had good or complete pain relief, the mean visual analogue scale pain score was 0.82. The mean grip strength improved and postoperatively was 11 kg (Jamar). The mean total ROM of flexion–extension was 72.3 degrees; radial–ulnar deviation 24.9 degrees. The mean QuickDASH score of 49 and patient rate wrist/hand evaluation of 41.7 a revision surgical procedure in six cases (26%): in two cases, a carpal component revision procedure and in four cases, total implant failures requiring either conversion to a Swanson spacer or wrist joint fusion. Conclusion TWA provides pain relief, preserves motion, and improves function in severe degenerative RA. Our results at a mid- to long-term follow-up with the U2 prosthesis were encouraging and represent, when indicated, a valid alternative to fusion which is less appealing for RA patients. Level of Evidence Level of evidence is therapeutic IV.

scholarly journals Long-Term Dietary Changes after Diagnosis of Rheumatoid Arthritis in Swedish Women: Data from a Population-Based Cohort

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Cecilia Lourdudoss ◽  
Laurent Arnaud ◽  
Alicja Wolk ◽  
Ronald F. van Vollenhoven ◽  
Daniela Di Giuseppe
Keyword(s):  
Rheumatoid Arthritis ◽  
Population Based ◽  
Wheat Bread ◽  
Dietary Recommendations ◽  
Animal Products ◽  
Dietary Changes ◽  
Whole Wheat Bread ◽  
Significant Difference ◽  
Over Time

Objective. To investigate long-term dietary changes after rheumatoid arthritis (RA) diagnosis in Swedish women, compared to women without RA.Methods. This study included 21,602 women from the Swedish Mammography Cohort (SMC), who completed dietary questionnaires in 1997 and 2009. Between 1997 and 2009, 191 women were diagnosed with RA. Dietary changes after RA diagnosis were analyzed based on intake of 82 food items. Statistical analysis included linear mixed models.Results. Women with RA, compared to women without RA, had significantly lower intake (mean servings per week) of animal products such as black pudding, egg, kidney, and liver paste (2.94±2.73 versus 2.45±1.82, p=0.010) and dairy products (35.14±20.02 versus 28.42±16.10, p=0.040) in 1997 and of cereals and grains (31.01±15.54 versus 28.00±14.98, p=0.009) in 2009. However, multivariable adjusted changes in dietary intake from 1997 to 2009 did not show any significant difference in intake. Nevertheless, women without RA increased their intake of whole wheat bread, wheat/oat bran, and rice more than women with RA.Conclusion. Women who had been diagnosed with RA had similar dietary patterns over time as the general population; these women did not remarkably change their diet over time due to their disease. Dietary recommendations for RA patients are needed.

scholarly journals Deactivation of Distant Pain-Related Regions Induced by 20-day rTMS: A Case Study of Oneweek Pain Relief for Long-Term Intractable Deafferentation Pain

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. E99-E105
Author(s):  
Wen-Dong Xu
Keyword(s):  
Case Report ◽  
Pain Relief ◽  
Motor Cortex ◽  
Caudate Nucleus ◽  
Cortical Plasticity ◽  
Motor Cortex Stimulation ◽  
Deafferentation Pain ◽  
Significant Difference ◽  
Stimulation Of

Background: Deafferentation pain secondary to brachial plexus avulsion, spinal cord injury, and other peripheral nerve injuries is often refractory to conventional treatments. Stimulation of the primary motor cortex (M1) has been proven to be an effective treatment for intractable deafferentation pain. The mechanisms underlying the attenuation of deafferentation pain by motor cortex stimulation remain hypothetical. Objectives: The purpose of this case report is to: (1) summarize a case in which a patient suffering chronic intractable deafferentation pain for 25 years underwent rTMS treatment over M1, (2) describe the evidence from PET imaging, and (3) reveal a possible relief mechanism with cortical plasticity. Study design: Case report. Setting: University hospital. Results: This patient had successful pain control with no transient or lasting side effects. The pain relief remained stable for at least one week. At the end of the 20-day procedure, pain relief was obtained according to the Visual Analog Scale (VAS) (-34.6%) and the McGill Pain Questionnaire (MPQ) (-31.6%). In the PET/CT scans, the glucose metabolism was significantly reduced contralaterally to the pain side in the anterior cingulate cortex (ACC), insula, and caudate nucleus. There was no statistically significant difference in any other cortical area. Limitations: Single case of a patient with long-term intractable deafferentation pain having a PET study. Conclusion: This study implies that a single session of 20 Hz rTMS over the motor cortex could reduce the pain level in patients suffering from long-term, intractable deafferentation pain. The stimulation of the M1 induces deactivation in the ACC, insula, and caudate nucleus. The changes in these pain-related regions may mirror an adaptive mechanism to pain relief after rTMS treatment. Key words: Neuropathic pain management, deafferentation pain, transcranial magnetic stimulation, motor cortex stimulation, cortical plasticity, positron emission tomography

TNF-alpha immunosuppressive use and future malignancy risk.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10558-10558
Author(s):  
Conor Driscoll ◽  
Kaitlyn O'Shea ◽  
Hui Zhang ◽  
Jordan Rich ◽  
Christopher Yang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Relative Risk ◽  
Ankylosing Spondylitis ◽  
Cancer Risk ◽  
Smoking Status ◽  
Necrosis Factor Alpha ◽  
Significant Difference ◽  
Risk Of Malignancy

10558 Background: Tumor Necrosis Factor Alpha (TNF-a) inhibitors suppress the immune system in patients with systemic inflammatory conditions. Long term data assessing future cancer risk for these patients is not known. We assessed long term risk of malignancy in patients with Rheumatoid Arthritis [RA], Inflammatory Bowel Disease [IBD], Psoriasis [PS], and Ankylosing Spondylitis [AS], who were or were not exposed to a TNF-a inhibitor. Methods: This was a retrospective, cohort study conducted using electronic medical record data for patients with complete demographic and treatment data at Northwestern Medicine from years 1998 to 2020 (RA: n = 10763; IBD: n = 12106; PS: n = 1920; AS: n = 5103). Inverse Probability of Treatment Weighting (IPTW) was used to balance the distributions of age, race, gender, smoking status, and follow-up time across exposure groups within each inflammatory condition type. Relative risk (RR) of malignancy based on TNF-a exposure was assessed using logistic regression. Results: 2583 (24.0%) of RA, 2185 (18.0%) of IBD, 1811 (94.3%) of PS, 572 (11.2%) of AS patients had TNF-a exposure. Median follow-up for patients was 43 months. The RR for any cancer was higher for patients exposed to a TNF-a agent with rheumatoid arthritis (RR 1.121 (95% CI 1.02-1.23, p = 0.015) and psoriasis (RR 1.763 (95% CI 1.32-2.37, p < 0.001). The relative risk of any cancer was lower in patients exposed to a TNF-a agent with IBD (RR 0.858 (95% CI 0.78-0.94, p = 0.001). No significant difference in relative risk associated with TNF-a exposure was detected with ankylosing spondylitis (RR 0.929 (95% CI 0.8-1.08, p = 0.344). Conclusions: Patients with RA or PS and TNF-a exposure had higher RR of overall malignancy. Patients with IBD and TNF-a exposure had lower risk of overall malignancy. TNF-a immunosuppression may alter cancer risk differently based on the disease states for which it is being used. This information is critical when counseling patients on long term risk and screening strategies when considering TNF-a inhibition.

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