Rheumatoid Arthritis: Schmidt K

Schmidt K, Rüther W. · Klinik für Orthopädie und Rheumaorthopädie, Katholisches Krankenhaus Dortmund-West, Zollernstrasse 40, 44379, Dortmund. · Z Rheumatol. · Pubmed #18779969 No free full text.

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Schmidt K. · Abteilung für Orthopädie, Unfallchirurgie, Rheumaorthopädie, Katholisches Krankenhaus Dortmund-West, St. Rochus Hospital Castrop-Rauxel, Zollernstr. 40, 44379, Dortmund. · Z Rheumatol. · Pubmed #18777028 No free full text.

Abstract: With the progression of rheumatoid arthritis more than half of the patients develop an affection of the elbow. Rheumatoid arthritis is the most common cause of elbow arthritis. The complexity of the rheumatic disease, which typically affects many joints, demands an individual therapeutic plan that can only be developed and accomplished successfully, when rheumatologists, rheumatoid surgeons and other specialists cooperate. Consistent use of approved and improved pharmaceuticals is abating the rate of rheumatoid cubarthritis. In cases of recurrent cubarthritis despite adequate medication, adverse reactions and other problems should be borne in mind before making a decision to change to more aggressive medication or synovectomy. Minimally invasive local measures, such as synoviorthesis and arthroscopic synovectomy can relieve pain and swelling, however, if lesions of the cartilage already exist, progressive joint destruction cannot be prevented. In early phases of rheumatoid cubarthritis with tight ligaments and thin synovial lining we prefer synoviothesis. In cases with recurrent cubarthritis after synoviorthesis or strong proliferation of the tunica synovialis, arthroscopic synovectomy is advantageous. Arthroscopic synovectomy is most effective in cases when there is ligament laxity in the sense of a late synovectomy, as removal of loose bodies, smoothening of the cartilage, release of the joint capsule and possibly arthroscopy-assisted resection of the radius head can be performed.

Sreedharan A, Bowyer S, Wallace CA, Robertson MJ, Schmidt K, Woolfrey AE, Nelson RP. · Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. · Bone Marrow Transplant. · Pubmed #16501594 No free full text.

Abstract: Autologous hematopoietic cell transplantation (HCT) is being used to treat autoimmune diseases refractory to conventional therapy, including rheumatoid arthritis. Macrophage activation syndrome (MAS) is a descriptive term for a systemic inflammatory disorder that has been described in patients with juvenile rheumatoid arthritis (JRA). This case report describes a young adult with systemic JRA (sJRA) who developed MAS on day # 12 post-autologous transplantation. The patient developed high fever, laboratory evidence of disseminated intravascular coagulation (DIC), hepatocellular injury, pancytopenia and hyper-ferritinemia. All viral, bacterial and fungal studies were negative and the patient improved with high-dose glucocorticosteroid and cyclosporine therapy. Extreme elevation of serum ferritin was documented and helpful in monitoring response to therapy. A number of systemic inflammatory syndromes have been described in association with HCT. These include DIC, 'engraftment syndrome,' infection-associated hemophagocytic syndrome and familial hemophagocytic lymphohistiocytosis. Macrophage activation syndrome presents with features of DIC and is closely related or identical to infection-associated hemophagocytic syndrome. The diagnosis needs to be established in a timely fashion because early and appropriate treatment may improve outcome.

Schmidt K. · Abteilung für Orthopädie und Rheumaorthopädie, Katholisches Krankenhaus Dortmund-West. · Orthopade. · Pubmed #15616808 No free full text.

Abstract: In rheumatoid arthritis the complex biomechanics of the hand is impaired due to elongation of ligaments and displacement of tendons. This results in eccentric transfer of high loads to the arthritic joints. This pathological load transmission remains frequently after joint replacement. This is the main reason for the high failure rate after arthroplasty in the hand. Therefore, most of the endoprostheses are no longer in use. As long as techniques for reliable reconstruction of the periarticular structures have not been established, silicon arthroplasty will remain the golden standard. Arthroplasty of the wrist and the PIP joints is seldom performed. After arthrodesis of these joints, the function of the hand is sufficient and complications are seldom. Midterm results after resectional arthroplasty of the CMC-I joint show less complications and results comparable with silicon arthroplasty.

Schmidt K, Knorth H, Willburger RE. · Abteilung für Rheumaorthopädie, Orthopädische Universitätsklinik, St.Josef Hospital Bochum. · Orthopade. · Pubmed #12486540 No free full text.

Abstract: With the progression of rheumatoid arthritis (RA),more than half of the patients develop an affliction of the elbow.Cub arthritis has to be regarded as a part of systemic rheumatoid disease. Thus, the indication for operative treatment depends not only on local changes but is determined by the pattern of all affected joints, the activity of the basic rheumatic disease as well as the effect of physical therapy and medication. The complexity of the rheumatic disease, which typically affects many joints, demands an individual therapeutic plan that can only be developed and accomplished successfully when rheumatologists, rheumatoid surgeons and other specialists cooperate. In cases of recurrent cub arthritis,in spite of adequate medication, synoviorthesis or synovectomy should be performed. This may relieve pain and swelling,however if lesions of the cartilage already exist,progressive joint destruction cannot be prevented. Arthroscopic surgery of the elbow provides all of the known advantages of minimal traumatisation. In RA,it is used mainly when there is ligament laxity in late synovectomies eventually combined with arthroscopically assisted resection of caput radii. In contrast to monoarticular diseases in RA,the adjoining bursa olecrani, neighbouring joints and nerve entrapment syndromes also require treatment. The treatment for advanced cub arthritis is arthroplasty. Due to progress in the development of elbow endoprotheses, the range of indications for resection (interposition) arthroplasty has increased.It is now preferred mainly in younger patients with ankylosing arthritis. Rheumatoid changes in the bone and soft tissue impede the implantation of artificial joints and require time consuming and precise preparation techniques. When choosing either an unconstrained or semi-constrained prosthesis,one has to bear in mind the actual ligament stability and its often unpredictable changes during the course of the disease.Perioperative measures, postoperative care and therapy is made even more difficult due to the involvement of several joints, often extensive permanent medication, secondary lesions such as ldquo;corticoid skin" and in most cases the multimorbidity of patients after many years of chronic disease.When comparing elbow surgery in osteoarthritis and RA,we found that patients with RA clearly required more elaborate surgery and more extensive perioperative and postoperative care.

Schmidt K, Willburger R, Ossowski A, Miehlke RK. · Department of Orthopaedic Rheumatology, Ruhr-University Bochum, St Josef Hospital, Bochum and St Josef Stift, Sendenhorst, Germany. Klaus.J.Schmidt-2@ruhr-uni-bochum-de · J Hand Surg Br. · Pubmed #10597932 No free full text.

Abstract: After silicone arthroplasty of the metacarpophalangeal (MP) joint there is increasing osteolysis, subsidence and fracture of the implants in the longer postoperative term. In 44 patients with rheumatoid arthritis (54 hands) 151 arthroplasties of the metacarpophalangeal joint were assessed at a mean of 3.9 years postoperatively. In 57 arthroplasties titanium protectors (grommets) were used. There were no significant differences in the clinical outcomes with respect to swelling, correction of ulnar deviation, range of active movement and grip strength. The additional use of grommets in MP joint arthroplasty slightly reduced reactive osteolysis, protected the spacers from breakage and slightly reduced the amount of pain with only a few additional complications in the midterm follow-up.

Hilker A, Miehlke RK, Schmidt K. · Klinik für Rheumaorthopädie, Handchirurgie und Endoprothetik, Orthopädische Klinik Volmarstein, Lothar-Gau-Strasse 11, 58300, Wetter, Germany. · Z Rheumatol. · Pubmed #17717677 No free full text.

Abstract: Only a few of the large number of implants developed during the last decades for replacement of the metacarpophalangeal (MCP) joint have proven to be reliable. The rates of loosening and mechanical failure of almost all types of constrained prostheses are so high that their use cannot be recommended at present. For more than 40 years silicone arthroplasty according to Swanson has been regarded as the gold standard in the prosthetic replacement of the MCP joint. In long-term studies this device provided good pain relief and a lasting correction of preoperative ulnar deviation. The degree of patient satisfaction continues to be high after more than 10 years. With the NeuFlex spacer, a modification of the original Swanson implant, a better range of motion and a reduction of wear-related problems is expected. In this study the results of 130 NeuFlex spacers after a mean time of 3.6 years were examined and 82% of the patients were completely pain free. The mobility of the joints improved from 40 degrees preoperatively to 54 degrees after 3.6 years. Radiologically periprosthetic erosions or osteolyses were seen in approximately 15% of implants. A minimal sinking of the stems developed in 24%, a massive one in 6% and 13% of the spacers were broken. Thus the use of the NeuFlex implant resulted in a better range of motion compared to the Swanson spacer, but the problem of radiological appearance remained unchanged.For unlinked prostheses sufficient soft tissue stability is mandatory as well as wear-resistant surface materials. The pyrocarbon prosthesis according to Beckenbaugh is the only implant for which long-term results are available. In a prospective study we evaluated 28 Ascension pyrocarbon prostheses with a mean follow-up of 4 years. Stability was not found to be a problem. Subjective results were satisfactory, the range of motion remained unchanged, however 46% of prosthesis stems exhibited radiolucent seams, 7 prostheses (25%) were rated as loose and 5 of those had to be replaced by a silicone implant. Use of the implant was abandoned, as it was unreliable regarding bony fixation. There are promising concepts in some new prostheses but independent data are still lacking.

Schmidt K, Hilker A, Miehlke RK. · Abteilung für Orthopädie und Rheumatologie, Katholisches Krankenhaus Dortmund-West, Zollernstrasse 40, 44379 Dortmund. · Orthopade. · Pubmed #17641872 No free full text.

Abstract: Between 1987 and 2005, 165 patients with rheumatoid arthritis of the elbow, four with psoriatic arthritis, and eight with osteoarthrosis of the elbow were treated with total elbow arthroplasty using 126 semiconstrained GSB III elbow replacement prostheses; 46 semiconstrained Coonrad-Morrey prostheses; 24 Souter-Strathclyde unconstrained, unlinked prosthesis; four constrained link hinge prostheses; two custom-made prostheses; and one Pritchard elbow replacement. All implant procedures relieved pain and improved functionality. The complication rate was 34.4%. Revision surgery was needed in 27.2% of elbows because of infection, dislocation, or aseptic loosening. Survival of the semiconstrained implants with ventral or epicondylar flanges for load transfer was better than that of the other implants. Component linkage with the Coonrad-Morrey implant prevents dislocation without increasing the risk of loosening; therefore, semiconstrained implants are our choice for advanced arthritis of the elbow. Total elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients.

Jäckel WH, Beyer WF, Droste U, Engel JM, Genth E, Kohlmann T, Kriegel W, Mau W, Pott HG, Rehberg W, Sangha O, Schmidt K, Wassenberg S, Zink A. · Hochrhein-Institut für Rehabilitationsforschung Bergseestr. 61 79713 Bad Säckingen, Germany. · Z Rheumatol. · Pubmed #11759234 No free full text.

Abstract: By application of a standardized core set of outcome measurement instruments, comparison between studies as well as meta-analyses in rehabilitation research can be facilitated. The German Society for Rheumatology has commissioned its working group on rehabilitation with the development of a proposal for such a core set of outcome measurement instruments. In a first step, dimensions for outcome measurement in rehabilitation were defined by a group of experts which represented rehabilitation hospitals, acute care hospitals, and research groups specialized in outcome measurement. The Delphi method was used in a multiple step consensus process. In a second step, instruments and procedures to operationalize the relevant dimensions were chosen. Reliability, validity, sensitivity to change, and practicability were used as criteria for selecting measurement instruments. The main intention of the proposed core set of outcome measurement instruments is to facilitate the processes of planning and carrying out rehabilitation research studies. Furthermore, the proposed instruments can be used for clinical documentation systems as well as for internal or external quality assurance programs.

Schmidt K, Willburger RE, Grosser S. · Abteilung für Rheumaorthopädie, St. Josef-Hospital, Orthopädische Universitätsklinik, Ruhr-Universität Bochum. · Orthopade. · Pubmed #11480089 No free full text.

Abstract: Omarthritis occurs frequently during the early course of rheumatoid arthritis. Many rheumatoid patients ignore omarthritis because of the good compensation mechanism of the shoulder. Sonography and tomography enable early diagnosis of omarthritis before deterioration is radiologically visible. Arthroplasty gives better results when the musculotendinous rotator cuff is still intact. Therefore, arthroplasty should be performed before severe damage develops. Early indication for cup arthroplasty of the humeral head is justified because of better options in revision surgery. Glenoid components show a high incidence of radiolucency and loosening in rheumatoid patients. Cemented hemiarthroplasties show the lowest rate of loosening.

Günter T, Schmidt K, Schmitt J, Leppek R, Lengsfeld M. · Abteilung für Endoprothetik des Lubinus-Clinicum Kiel. · Handchir Mikrochir Plast Chir. · Pubmed #11468900 No free full text.

Abstract: In order to investigate the influence of stem length in finger joint prostheses on stress in the surrounding bone area, finite element (FEM) calculations of finger bones before and after prosthetic replacement of metacarpophalangeal joints with cementless implants of different stem length were performed. CT scans of the metacarpal bone and proximal phalanx before and after implantation of a prototype of a noncemented semiconstrained implant for the MP joint, which has been developed to replace metacarpophalangeal joints destroyed by rheumatoid arthritis, were analysed. The FEM calculations showed comparatively decreased differences of the von-Mises stress after implantation of intramedullary stems reaching the middle of the diaphysis. At the metaphysis of the metacarpal head we found an increase of the von-Mises stress of 1.3 MPa (Mega Pascal = 10(6) Pa), an increase of 18.9 MPa around the shortest prosthesis and a decrease of 21.4 MPa around the prosthesis with the longest stem.

Schmidt K, Willburger RE, Miehlke RK, Witt K. · Department of Orthopaedic Rheumatology, Ruhr University Bochum, Germany. · Scand J Plast Reconstr Surg Hand Surg. · Pubmed #10614754 No free full text.

Abstract: In resection arthroplasty of destroyed metacarpophalangeal joints stabilisation with a silicone spacer is regarded as the gold standard. In 28 patients with rheumatoid arthritis (34 hands) 102 arthroplasties of the metacarpophalangeal joint were assessed a median of 10 years postoperatively (range 8.7-12.5). All patients reported pronounced subjective relief of pain, and in three quarters function of the hand had improved. The median active range of movement decreased from 40 degrees (range 10 degrees-90 degrees) preoperatively to 35 degrees (range 5 degrees-85 degrees) postoperatively. Ulnar deviation was corrected from a median of 35 degrees (range 0 degrees-60 degrees) preoperatively to 10 degrees (range 0 degrees-40 degrees) postoperatively. The extension deficit was improved from a median of 35 degrees (range 10 degrees-80 degrees) before surgery to a median of 10 degrees (range 0 degrees-30 degrees) at follow up. Grip strength remained unchanged. Radiological examination showed surrounding osteolysis in 89% of the implants and 28% had broken. The well-known discrepancy between fair clinical and good subjective results with distinct radiological findings such as osteolysis was therefore confirmed. Material fatigue and sharp bony edges that result from osteolysis may be the cause of the relatively common implant fractures and ulnar deviation in this long-term follow-up.