Diagnosis and Treatment of Erosive Rheumatoid Arthritis and Other Forms of Joint Destruction

Single or multiple destruction of joints arises from many causes, ranging from the acute destructive process (usually monarticular) in septic joint disease to the chronic, slowly evolving destruction of cartilage and adjacent bone that occurs in osteoarthritis. Medical treatment of a few of these conditions (including rheumatoid arthritis) is reasonably satisfactory if it is initiated early. On the other hand, surgical procedures are indicated if physical and X-ray examination of the involved joints discloses the presence of a significant destructive process involving both articular cartilage and bone. Several very satisfactory such operative techniques, including synovectomy (in the relatively early phases) and prosthetic joint replacement, have been recently developed. These are especially favorable in destructive disease of the hip, knee, or small joints of the hand. The various differential diagnostic, radiographic medical, and surgical procedures are discussed in some detail in this conference.