SURGICAL TREATMENT OF LYMPHEDEMA IN PATIENTS WITH RHEUMATOID ARTHRITIS: PERSPECTIVES OF VASCULAR SURGERY AND RHEUMATOLOGY

Abstract

Introduction: Lymphedema is a condition that affects lymphatic drainage, leading to fluid accumulation and swelling, frequently observed in patients with rheumatoid arthritis (RA). The interaction between RA and lymphedema complicates clinical management, since chronic inflammation from arthritis can aggravate lymphedema symptoms. Surgical treatment, which includes approaches such as liposuction and lymphatic bypass surgery, has gained prominence in recent decades, presenting itself as a promising option for patients who do not respond adequately to conservative therapies. Collaboration between specialists in vascular surgery and rheumatology is essential to optimize clinical outcomes and quality of life of affected patients. Objective: To explore the perspectives of surgical treatment of lymphedema in patients with rheumatoid arthritis, analyzing the efficacy and safety of available surgical interventions. Methodology: The PRISMA checklist criteria were followed to conduct the review, using the PubMed, Scielo, and Web of Science databases. The descriptors used included "lymphedema", "rheumatoid arthritis", "surgery", "treatment", and "vascular surgery". Inclusion criteria consisted of: studies published in the last ten years, focused on surgical interventions for lymphedema in patients with RA, and that presented relevant clinical data. Exclusion criteria included articles that did not directly discuss surgery, those with samples from patients without RA, and reviews or opinions that did not contain original data. Results: The results indicated that surgical interventions provided significant improvements in quality of life and in the reduction of lymphedema symptoms. Liposuction, in particular, stood out as an effective technique for the management of lymphedema, showing reduction in the volume of the affected limb and improvement in function. The integration of multidisciplinary teams was considered essential for the success of the treatments. Conclusion: Surgical treatment of lymphedema in patients with rheumatoid arthritis has shown promise, demonstrating significant benefits. The combination of appropriate surgical techniques and collaboration between specialists in vascular surgery and rheumatology were crucial to optimize clinical outcomes. Future studies are needed to establish standardized protocols and assess the durability of long-term results.