Rheumatoid arthritis is the most common chronic inflammatory arthritis affecting roughly 1% of adults with a predilection for females. The disease is characterized by symmetrical polyarthropathy and significant systemic involvement.
Signs and Symptoms of RA:
- Joint Involvement: hands, wrists, knees, temporomandibular joint, cervical spine (atlantoaxial subluxation, odontoid process may compress the spinal cord).
- Systemic Involvement: Cardiovascular: pericardial effusion, pericarditis, myocarditis, coronary arteritis, cardiac valve fibrosis, rheumatoid nodules in cardiac conduction system. Lungs: pleural effusion, interstitial inflammation and fibrosis, restrictive changes with decreased lung volumes and vital capacity. Neuromuscular: entrapment neuropathies.
Management of anesthesia: Multiple organ system involvement and side effects of drugs (coagulation, adrenal gland suppression) used to treat RA are to be appreciated when planning the management of anesthesia. Preoperatively, patients should be evaluated for airway problems due to disease process (cervical spine, TMJ, cricoarytenoid joints). Flexion deformity of cervical spine may lead to airway obstruction with induction of anesthesia. Atlantoaxial subluxation (by radiographic confirmation) may increase the risk of cervical spinal cord compression; avoid excessive movements of the neck during laryngoscopy; determine head positions awake that can be tolerated. Limitation of TMJ mobility plus cervical spine immobility may limit visualization for DL (may need to consider awake fiberoptic).