Conquering orthopaedic connections

Aching joints are common in arthritis. In rheumatoid arthritis, the joint lining swells, invades surrounding tissues and produces chemical substances that attack and destroy the joint surface. Speaking to Marlene Debono, one of the living testimonies of the success of surgical treatment, Moira Mizzi discovers more...

The problem with being blessed with abundance is that we tend to lose sight of the basic things that support us in our everyday life. Where our body is concerned, we keep its appearance in the limelight more than its functionality; until we lose part or all of it.

A human adult has an average of 200 joints in his body, and their role is to provide efficient movement and functionality. Everything that we do from walking to a destination or playing a game of tennis or football to threading a needle or fastening a button requires the full functioning of our joints. As a result, anything that hinders that efficiency can seriously undermine our quality of life as 60-year-old Marlene Debono discovered in the past 30 years.

Ms Debono started getting pain and swelling in the joints of her hands and feet by the time she was 30. She was diagnosed with rheumatoid arthritis soon after. “I was also diagnosed with a heart problem at the time so could not take anything for the pain,” she explains in her melodious voice “so I had no option but learn to live with it” she continues with a sigh “at the time I was married with three very young children so the situation presented quite a challenge to me,” she concludes.

The joint pains and swelling kept coming and going in a relentless pattern, alternating between the joints of the hands and feet to other larger joints like the knees and wrist. With time these symptoms were compounded with deformity thus not allowing her to perform her daily activities. “There were times where I had to wait for a neighbour to pass by to help me zip up my dress or fasten my shoe laces as otherwise I would not even have been able to go out,” she reminisces her voice tuning in to a flatter tone, “at least the many aides like special forks, biros and splints got me a long way in performing necessary day- to-day functions”. Her eyes and voice suddenly pulsate with pride and love as she adds “Luckily I found a lot of support from my husband, he was my mast in all these rough times doing everything to make sure I could cope despite my limitations”.

Rheumatoid arthritis is an autoimmune condition where the individual’s own antibodies start reacting against his own joints resulting in inflammation and progressive destruction and deformity of the joints affected. It most commonly affects females in the prime of their life . The hallmark of the condition are joint pain, swelling, stiffness and deformity and the joints most commonly affected are the small joints of the hands, the wrist and the toes. Rheumatoid arthritis has no correlation whatsoever with the more common osteoarthritis which comes from natural “wear and tear” of the joints and affects both genders at a later stage in their lives even if we Maltese tend to dub all conditions affecting the joints “artrite”.

According to rheumatologist Bernard Coleiro, European studies show that the disease affects one per cent of the population locally mostly young to middle-aged females “I see about seven follow-up cases every week and there are three other consultant rheumatologists in our department which would give an approximate total figure of 30 patients per week,” he explains.

Up till a few years ago, the treatment regime centred around pain relief and anti-inflammatory medication which did very little to control the relentless progression of the disease in some cases. “Fortunately today the picture has changed radically” Dr Coleiro explains with satisfaction. “Today we have treatment regimes that incorporate what are called disease-modifying drugs, which not only control the pain but are potent enough to slow down and in some cases halt the progression of the disease and its deleterious effects if started early enough,” he continues. “Initially these drugs were left as a last resort in the treatment plan but now we have fully realised the importance of starting them as soon as a diagnosis of rheumatoid arthritis is made,” he concludes.

Dr Coleiro stresses that with the advent of these drugs it has become even more important for the patient to seek medical advice as soon as he or she notices any symptoms. “It is important that the patients realise that if they do not seek help early on these drugs, potent though they are, still cannot reverse the damage that would have set in,” he states emphatically. “It is important that patients appreciate the financial strain they put themselves and the country through as a result not to mention the poorer quality of life they set themselves up to; that is why our goal to treat to target is no less than to achieve remission,” he concludes strongly.

In fact patients who fail to seek treatment early on, or patients like Ms Debono who did not have the opportunity to have these disease modifying drugs at the time of their diagnoses, have to contend with the cosmetic and functional constraints brought about by the deformities, that are an inevitable end-result of inadequately treated or untreated disease. Fortunately, the doors are not closed in the face of such patients and despite it indicating “medical failure” as defined by Dr Coleiro, surgery nowadays offers them a lot of hope.

According to orthopaedic surgeon and hand specialist Jason Zammit surgery for rheumatoid arthritis patients comes in two main categories: arthrodesis (joint procedures or fusion) and arthroplasty (joint replacement).

“The fusing of joints is important to put the joints back in a functional position,” he explains, “joint replacements or arthroplasty on the other hand is newer on the hand surgery agenda and it involves the use of silicon or pyrocarbon implants to replace the bony and cartilaginous substance eroded away by the disease”, he continues.

“Luckily, with the vast improvement in medical treatment for rheumatoid arthritis we only get to treat the most refractory cases nowadays” he concludes with satisfaction.

Fortunately, rejection is rare and the post-operation period is usually uneventful. “What is so amazing about these procedures is that the patient usually responds very well despite the disease process and the anti-inflammatory drugs they would have been on for so many years which usually hinder the healing mechanism,” Mr Zammit enthuses.

After a number of operations in her hands and feet, Ms Debono is one of the living testimonies of the success of surgical treatment. As she prepares excitedly to celebrate her sixtieth birthday in a few weeks’ time she is just as excited to enjoy her highly improved quality of life with less pain and less dependency on the aides she had to use in the past to boost her joint function. And she doesn’t stop there as for a couple of years now she has also been doing voluntary work at the outpatients department in Mater Dei Hospital sharing her experience with others and giving them the courage and hope which supported her so much during her dark days.

Ironically, quality of life, like disease, can be infectious/contagious.

• Dr Mizzi is one of the medics at a top cosmetic clinic.