Perioperative Care for Rheumatoid Foot and Ankle Surgery Patients

Abstract

tating and leads to progressive joint inflammation and destruction, with subsequent functional impairment. The hands and legs are most commonly involved, with women more frequently affected than men, and the most common age groups affected lie between 40 and 60 years. Juvenile RA is the most common form of childhood arthritis, yet its clinical pattern usually differs from that of adult RA. The exact cause of RA is unknown but research points toward a genetic predisposition with certain infections or environmental factors that might trigger the activation of the immune system in susceptible individuals. Immune cells, called lymphocytes, are activated and cytokines, such as tumor necrosis factor (TNF) and interleukins 1 and 6 are expressed in the inflamed areas leading to articular effusions. Synovial hypertrophy contributes to the formation of synovial pannus, which selectively causes destruction to periarticular structures, cartilage, and bone. RA can affect any joint including the hand, wrist, elbow, shoulders, hip, knee, foot, ankle, and cervical spine. Nearly 100% of patients report foot problems within 10 years of RA onset. 3–5 Sites of involvement often coincide with the duration of the disease, with forefoot involvement occurring much earlier