Does Your Wrist Hurt?
Sometimes we think it is an ailment associated with old age, but it is not
The earlier it is detected and treated, the better the prognosis. Here is more information.
Waking up in the morning feeling tired, accompanied by numbness and stiffness in one or more joints, without swelling, are early signs of possible rheumatoid arthritis (RA). It is difficult to accept this possibility, but statistics indicate that one in one hundred people develops this autoimmune disease. Additionally, it is three times more common in women. “In my case, it started with knee pain. At first, we thought it was a meniscus issue because I liked playing sports and practicing ‘steps’ (step aerobics), but then the malaise became general, and pain appeared in my elbows, neck, and left wrist,” says Verónica Briceño. It was 1996, she was 36 years old and traveling to Spain to pursue a doctorate. “It was a very aggressive rheumatoid arthritis, but once I started taking medication, I improved, but the pain persisted,” says Verónica, who, upon finishing her studies in Spain, returned to Peru and sought specialized help. It is unknown what causes RA, but it is known that genetic factors (perhaps you have relatives with this problem, like Verónica) and environmental factors converge in its development. Smoking is one of them. For some reason, which is not clear, the immune system mistakenly attacks healthy tissue cells in the synovial membrane, the tissue lining the joint.
Smokers have a 50% higher risk of not responding favorably to treatments used at the onset of rheumatoid arthritis.
In response, the immune system releases chemicals that cause inflammation. If the inflammatory process is not stopped—the goal of drug treatment—the cartilage and surrounding bone of the joint are damaged. Therefore, it is not a disease exclusive to old age, as is often believed.
The intensity and course of the disease vary from person to person
In 60% of patients, it is permanent; in 20%, it is fluctuating (with episodes of flare-ups and remission lasting months or years), and in 20% of patients, disease remission is achieved after six months of treatment. Living with RA is not a sentence to be in constant pain. It is necessary to seek help and evaluate different alternatives. Briceño, the woman who could not find rest for her pain, underwent surgery and today runs and practices Tae Bo with a smile.
This is an extreme alternative when the joint has been damaged and is non-functional. In these cases, joint implants, such as prostheses, can be used. The joints most operated on for rheumatoid arthritis are the hip and knee, but there are also techniques for the small joints of the hand and wrist that preserve function. “Nowadays, many patients already have shoulder, elbow, and wrist prostheses; also for the base of the thumb and the interphalangeal joints of the fingers. All are outpatient interventions,” comments Dr. Alejandro Badia, hand and upper extremity surgeon at the Badia Hand to Shoulder Center in Miami. Verónica Briceño was operated on 10 years ago by Dr. Badia. “In the past, the treatment for rheumatoid arthritis of the wrist that did not respond to any other treatment was total wrist fusion. But this can now be avoided because rheumatoid arthritis rarely affects all the wrist joints, and because currently there are several mobility-preserving procedures that can yield very good results, as in Verónica’s case,” explains Dr. Badia. These techniques are not practiced in the country, but there would be interest in opening a specialized center with Dr. Badia’s advice.
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