Surgical treatment of juvenile rheumatoid arthritis.
There is no general agreement about the role of surgery in the treatment of juvenile chronic arthritis patients. It is very natural that in the case of the growing child, the surgical armament is limited to prophylactic procedures, and reconstructive operations are rather rare. In Finland, with a population of 5 million people, slightly less than 1,000 children under the age of sixteen suffer from juvenile chronic arthritis. Among these, about half need to be hospitalized every now and then. Our institution covers about 85% of hospital treatment. Consequently, most cases with severe disease necessitating surgery are treated in one hospital. The annual number of operations has decreased markedly during the last ten years due to the more aggressive and more effective medical as well as other kinds of non-surgical treatment. Despite the active use of local steroid injections, tenosynovectomy is still necessary. Joint synovectomies are carried out today, when necessary, mostly arthroscopically. Major surgery such as joint replacement is very rare in patients under the age of sixteen. If necessary, closure of the growth plates must be awaited, and special custom-made prostheses are used in most cases. The small bones and some particular deformities typical of JRA patients present special challenges to the surgeon's skill. Consequently, the conducting of these types of surgery should be centralized in specialized clinics.
Rheumatism Foundation Hospital, Heinola, Finland.
M
M
Hämäläinen
D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*; D001175:Arthrography; D002648:Child; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography