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Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory disorder that can result in destruction of joints. The Arthritis Research Council has an excellent information booklet on the condition. The disease frequently affects the wrists, the hands involving the knuckles, metacarpo-phalangeal (MCP) joints and the middle, proximal interphalangeal (PIP) joints of the fingers.

The main indications for surgery are as follows:

  1. Failure of medical treatment to control symptoms
  2. The relief of pain
  3. To improve or recover function
  4. To prevent further destruction

Most patients that I see with rheumatoid arthritis affecting their hands, have been referred to me by their rheumatologist. At the Royal Berkshire Hospital I participate in a combined rheumatology/hand clinic with Dr Jeremy McNally (Consultant Rheumatologist) and Nikki Huxtable (Occupational Therapist). This clinic allows the assessment of all the disciplines as to whether surgery is an appropriate option.

The decision to offer surgery is based on a number of factors including the above mentioned main indications. However, it is critical that the whole body is taken into consideration as well. For example, it would be pointless operating on the hands if the patient was waiting to have a knee replacement and would need their hands to use crutches. Surgery for rheumatois arthritis is a multi-discipline team approach and will only be performed if all the issues are favourable. One of the problems with rheumatoid affected hands is that it can lead to a deformity which is cosmetically displeasing but often with remarkably little loss of function. I am reluctant to operate for cosmetic reasons as the risks and potential complications do not justify the surgery.

The main types of surgery in rheumatoid arthritis affected hands and wrists is as follows:

  1. Surgery to the soft tissues

  2. Surgery to the joints
  3. Further reading:

    1. British Society for Surgery of the Hand.
    2. American Society for Surgery of the Hand.