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Functional staging and surgical intervention of the elbow and shoulder joints in a patient with rheumatoid arthritis

Nature Clinical Practice Rheumatology volume 3, pages 112–117 (2007)Cite this article

Abstract

Background A 46-year-old, nonsmoking, nulliparous woman with a 23-year history of rheumatoid arthritis presented with severely destructed right shoulder, right elbow, and right wrist joints, which resulted in a complete loss of working ability.

Investigations Physical examination, X-ray, MRI, ultrasound, functional staging using the Shoulder Pain and Disability Index, the Patient Rated Elbow Evaluation, the Disabilities of the Arm, Shoulder and Hand, and the health-related quality-of-life Short Form 36 questionnaire, determination of the c-reactive protein level, erythrocyte sedimentation rate, Disease Activity Score 28 and the metalloproteinase profile, and histology of removed synovial tissue.

Diagnosis Severe destruction of the right shoulder and elbow (Larsen grade IV) resulting from late-stage seropositive rheumatoid arthritis.

Management Reconstruction of the elbow and ipsilateral shoulder in a two-step procedure: replacement of the elbow joint with a semiconstrained Gschwend-Scheier-Bahler III (GSB III™) elbow prosthesis (Zimmer, Inc., Warsaw, IN) followed by replacement of the shoulder with the Promos® Modular Shoulder System (Plus Orthopedics AG, Rotkreuz, Switzerland) 1 month later. The patient received 4 weeks of inpatient rehabilitation.

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Figure 1: Graph of the patient's number of involved joints and ability to work in the years before surgical intervention.
Figure 2: Radiographs of the patient's right elbow before and after surgery.
Figure 3: Radiographs of the patients' right shoulder before and after surgery.
Figure 4: Graph of the dimensions of health-related quality of life before and after surgery.
Figure 5: Histology sample of the synovium at the stage of removal (hematoxylin and eosin staining, ×100).

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Acknowledgements

This work was partially funded by the Georg and Bertha Schwyzer-Winiker foundation. We would like to thank Hans-Kaspar Schwyzer for advice, Susann Drerup for data processing and Caroline Ospelt for assistance with histologic imaging.

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Authors and Affiliations

  1. at the Upper Extremity department at the Schulthess Clinic, J Goldhahn is a Senior Researcher, C Kolling is a Research Fellow, and BR Simmen is Chairman, Zürich.,

    Jörg Goldhahn

  2. C Kolling is also a Research Fellow at the Center of Experimental Rheumatology, University Hospital Zürich, Zürich,

    Christoph Kolling

  3. BR Simmen is also a Member of the Board of the Schulthess Foundation and a Consultant Orthopedic Surgeon for Rheumatoid Arthritis Surgery at the Department of Rheumatology and at the Department of Paediatric Surgery of the University of Zürich, Zürich.,

    Beat R Simmen

  4. S Gay is the Head of the Center of Experimental Rheumatology at the University of Zürich, and is Director of the World Health Organization Collaborating Center for Molecular Biology and Novel Strategies for the Treatment of Rheumatic Diseases, Zürich, Switzerland.,

    Steffen Gay

Authors
  1. Jörg Goldhahn
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  2. Christoph Kolling
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  3. Steffen Gay
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  4. Beat R Simmen
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Corresponding author

Correspondence to Jörg Goldhahn.

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The authors declare no competing financial interests.

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Goldhahn, J., Kolling, C., Gay, S. et al. Functional staging and surgical intervention of the elbow and shoulder joints in a patient with rheumatoid arthritis. Nat Rev Rheumatol 3, 112–117 (2007). https://doi.org/10.1038/ncprheum0407

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