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Rheumatic Heart Disease III: Medical Management

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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
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Rheumatoid Hand Surgery in the Era of Biologic Therapy: A Rheumatologist-oriented Overview.

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Rheumatoid arthritis (RA) can damage hands and wrists. While biologics improve outcomes, surgery remains vital for severe cases, though its use varies, suggesting a need for better rheumatologist-surgeon communication.

Keywords:
Biologic therapyHandRheumatoid arthritisSurgeryWrist

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Area of Science:

  • Rheumatology
  • Hand Surgery
  • Orthopedics

Background:

  • Rheumatoid arthritis (RA) frequently causes significant hand and wrist dysfunction.
  • While biological therapies have improved remission rates, surgical intervention is still necessary for advanced RA.
  • Variations in surgical rates for RA hand procedures suggest clinical uncertainty.

Purpose of the Study:

  • To provide a review of common hand and wrist problems in RA patients.
  • To enhance rheumatologists' understanding of surgical options for RA.
  • To facilitate informed patient consultations and referrals to hand surgeons.

Main Methods:

  • Literature review of common rheumatoid hand and wrist conditions.
  • Overview of current surgical indications and procedures for RA.
  • Discussion of factors contributing to variations in surgical rates.

Main Results:

  • RA significantly impacts hand and wrist function, necessitating a multidisciplinary approach.
  • Biological therapies have reduced, but not eliminated, the need for surgery.
  • Discrepancies in surgical rates highlight potential gaps in interdisciplinary communication.

Conclusions:

  • Understanding surgical options is crucial for rheumatologists managing RA patients.
  • Improved communication between rheumatologists and hand surgeons can optimize treatment pathways.
  • Surgical intervention remains a key component in managing severe RA-related hand and wrist deformities and pain.