TYPES OF SURGERY FOR TREATMENT OF RHEUMATOID ARTHRITIS: ARTHROSCOPIC SURGERY AND SYNOVECTOMYArthroscopic SurgeryBy inserting a pencil-sized telescope called an arthroscope through a small incision in the skin, a surgeon or rheumatologist is able to look inside the joint without putting the patient through major surgery. Being able to see the inside joint structures helps the surgeon determine what conditions are creating problems. And, at the same time the surgeon is examining the inside of the joint, he or she can take a biopsy of tissue within the joint to confirm a diagnosis or perform simple corrective procedures such as removing damaged cartilage.More extensive surgical procedures such as ligament and tendon repairs can also be performed through an arthroscope. Arthroscopic synovectomy, in which inflamed synovial lining is removed, is another common procedure.
SynovectomySynovectomy is the name of the procedure in which destructive synovitis is removed. This inflamed joint lining (synovium) is removed surgically to prevent it from damaging cartilage and other joint structures. Although very effective in reducing joint pain and swelling, synovectomy should not be viewed as providing a permanent cure because the synovium can grow back, and complete removal of all synovial tissue is not possible.As discussed above, synovectomy can be performed through an arthroscope. This approach has an advantage over open surgical synovectomy in that it avoids cutting and opening the joint capsule surgically. For this reason, recovery from arthroscopic synovectomy is generally quite rapid.Although it is more invasive, an open surgical synovectomy also has certain advantages. It provides the surgeon a better view of, and improved access into, the total joint, thereby facilitating thorough removal of the inflamed synovial tissue.On the horizon are other forms of synovectomy which may be available. One is a form of laser synovectomy which is presently being developed. Using the arthroscope, the surgeon vaporizes the inflamed synovium with the laser. Care must be taken not to injure ligaments or underlying cartilage.The second measure is radiation synovectomy. This form of therapy has been used extensively in Europe and in a few academic centers in the United States. The procedure consists of injecting a radioactive substance directly into the joint to eliminate synovitis. It has not been widely accepted in this country because of concerns about radioactive leakage from the joint. New forms of joint injection therapy are being developed, though, as researchers are trying to design a chemical that will react exclusively with rheumatoid synovium. This form of chemical synovectomy may be extremely effective if a chemical can be formulated to seek out and destroy only the destructive tissues while preserving the healthy and important ones.*112/209/5*

EXERCISE AND RHEUMATOID ARTHRITIS: STARTING AN EXERCISE PROGRAMAn exercise program is made up of three crucial components: warm-up, workout, and cool-down. Most people find that an exercise program occupies about thirty minutes daily, usually ten minutes of warming up, fifteen minutes of working out, and five minutes of cooling down – but this may vary. You should never exercise to the point of extreme fatigue or exhaustion. Start low and go slow, and work your way up! In this way you can make progress without suffering setbacks.People with RA need to schedule their exercise to coincide with the time of day when they are most rested and have the least pain.Warm-upA warm-up is necessary to allow the joints and muscles to loosen up slowly, in preparation for the work out. Tight joints and muscles should not be exercised. Warm-up range-of-motion and stretching exercises prepare muscles for more intense exercise.WorkoutThe workout that’s best for you is determined by the degree of inflammation in your joints. Generally, unless your joints are very inflamed, a workout includes strengthening and aerobic exercises. When joints are very inflamed, the workout may consist only of range-of-motion exercises.Cool-downCool-down relaxes muscles and allows the heart rate and breathing rate to return to their before-workout rate. A cool-down also helps prevent post-exercise pain or anxiety. Cool-down exercises can be range-of-motion exercises or aerobic exercises performed in slow motion.*72/209/5*

It is important to understand that these symptoms, although they may seem to be the very first signals of approaching arthritis, are not at all the first symptoms of the onset of the disease. Arthritis is not a local disease of a particular joint but a systemic disorder, a disease which affects the whole body. It could have taken years and years of abuse to bring about the systemic disturbance in bodily functions which eventually leads to a breakdown of the health and the functions of the joints.

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