The drug treatment of rheumatoid arthritis has developed dramatically with the development of biologic disease-modifying antirheumatic drugs (bDMARDs) and JAK inhibitors. On the other hand, there are some cases with progressed joint destruction when adequate treatment is difficult due to old age or comorbidity, or difficulty in early diagnosis. In addition, the number of patients with osteoarthritis, in which cartilage degenerates with age, and osteoporosis, in which bones become fragile, is increasing every year. In our group, we mainly provide the following surgical treatments and drug therapies.
Deformities of the forefoot such as hallux valgus are common not only in rheumatoid arthritis patients but also in elderly patients. If the symptoms do not improve with conservative treatments such as plantar plates, surgical treatment is considered. In the past, surgical techniques such as excision and immobilization of the deformed joint were often used, but we have adopted a technique that preserves the patient's joint as much as possible.
We perform lateral column lengthening, talonavicular joint fixation, flexor digitorum longus transfer, and calcaneal tuberosity transfer for flat foot deformities, joint fixation for subtalar arthropathy, and V-shaped osteotomy and rotational osteotomy of the midfoot for cases of severe ankylosed deformity of the midfoot.
We consider surgical treatment for patients with ankle joint deformity and pain caused by osteoarthritis or rheumatoid arthritis when conservative treatments (medication, orthotics, joint injections, etc.) are not effective. Depending on the patient's condition, we perform distal tibial osteotomy, total ankle arthroplasty, and ankle joint fixation.
In rheumatoid arthritis and osteoarthritis, all joints may be subject to surgery. In our group, we mainly perform the above-mentioned foot surgeries. And we make decisions about the indications for surgery in other joints or spine during the course of treatment in the outpatient clinic. If surgical treatments are necessary, we will work closely with other groups in the Department of Orthopaedic Surgery of Osaka University to provide the adequate surgical treatments for the patient's condition.
In our group, we diagnose rheumatoid arthritis and provide drug therapy using anti-rheumatic drugs such as methotrexate, bDMARDs, and JAK inhibitors. We mainly receive referrals for cases with severe joint symptoms that have been difficult to diagnose and treat at other hospitals. We also collaborate with the Department of Respiratory Medicine and the Department of Immunology at Osaka University to treat patients with other autoimmune diseases or comorbidities difficult to treat. We actively collaborate with the community clinics by referring patients whose condition has stabilized to their previous doctors or affiliated hospitals.
We diagnose osteoporosis associated with rheumatoid arthritis and other bone metabolic diseases in adults, and introduce drug therapy according to the disease condition. In this case, tests such as bone density, bone metabolism markers, and bone metabolism-related hormones are performed to make diagnosis and treatment selection. Once the patient's condition is stabilized, we actively cooperate with the local community by referring the patient back to the previous doctor or affiliated hospital.