What is the recommended long-term treatment for a 66-year-old woman with rheumatoid arthritis and significant knee erosions?

• A. Physical therapy
• B. Bilateral knee replacement
• C. Medication adjustment
• D. Joint injections

Answer: (B)

In cases of rheumatoid arthritis (RA), particularly when it is advanced and accompanied by significant joint erosions, such as those seen in this 66-year-old woman, addressing the underlying structural damage and pain is crucial for improving quality of life. Bilateral knee replacement can be a highly effective long-term treatment option for patients who have developed severe joint degeneration that is unresponsive to conservative measures.

Knee replacement surgery aims to relieve pain, improve function, and restore mobility, making it appropriate for individuals with substantial joint erosion. It is especially indicated when the disease has led to significant loss of cartilage and is causing debilitating symptoms that interfere with daily activities.

While other options like physical therapy, medication adjustments, or joint injections may provide temporary relief or improve function, they often do not sufficiently address the severe structural changes present in advanced rheumatoid arthritis. These treatments typically aim to manage symptoms or slow progression but may not fully restore knee function or relieve pain in patients with severe joint deformities or erosions. In contrast, knee replacement offers a more definitive surgical solution for long-term management in such cases.