Rheumatic orthopedic pathology: an interdisciplinary approach to diagnosis and treatment. Literature review

Rheumatic pathology as a socially significant group of chronic immune-inflammatory diseases is a pressing problem in modern rheumatology and orthopedics. Its etiopathogenesis has not been fully studied, and late detection of the disease leads to early loss of ability to work and subsequent disability of patients. The definition of "rheumatic orthopedics" arose at the intersection of two disciplines – rheumatology and orthopedics. The first rheumatic orthopedic department was established in the middle of the last century at the V. A. Nasonova Research Institute in Moscow. The literature review was conducted as a result of studying 160 Russian and foreign primary sources published from 2018 to 2023. Research objective. To substantiate the importance and necessity of interaction between rheumatological and orthopedic services, to identify possible shortcomings and gaps in the process of perioperative management of patients. Currently, it is known that the prevalence of rheumatic pathology is 2.5 times higher than official statistics, and the risks of death due to concomitant diseases occur 10 years earlier. Laboratory indicators are not always informative, and the possibilities of a comprehensive assessment of the functional class and inflammatory activity indices are used only by such specialists as rheumatologists. Despite the understanding of this situation, early appeal of patients to outpatient clinics for medical care usually remains unattended, the time from the initial appointment to the establishment of the final diagnosis is up to 7 years. Late appeal of patients due to insufficient awareness of possible options for complex, including surgical, treatment significantly complicates the possibilities of timely orthopedic correction, increasing the risk of complications, despite the average survival rate of the implants used up to 70 % for 9 years. Insufficient knowledge of specialists of various profiles in matters of patient routing, determining indications for surgical treatment methods, and the possibilities of perioperative rehabilitation leads to late diagnosis and complicates the provision of timely surgical care. The use of surgical technologies in advanced cases of rheumatic diseases is associated with both intraoperative difficulties as a result of gross skeletal deformations and high risks of complications from concomitant diseases, which significantly complicates the work of not only rheumatology specialists, but also traumatologists-orthopedists.