Rheumatiod arthritis is a disease that damages the joints and tendons. Rheumatoid arthritis (RA) affects joints all over the body, but causes particular problems in the hands. RA is an autoimmune disease where the body attacks itself; it is quite different from the more common form of arthritis, osteoarthritis.
There have been very significant advances in the medical treatment of RA over the last 10 years. In addition to the older medicines such as steroids and methotrexate, newer 'disease modifying' drugs target the molecules produced by the body that cause the tissue damage. Most cases of RA can now be controlled with medical treatment. A rheumatologist, who specialises in joint problems, will usually make the initial diagnosis and advise on medical treatment. I work closely with a number of rheumatologists and see patients with RA when surgical treatment is being considered.
The main indications for surgery are impaired function of the hand and pain. Surgical treatments include:
Synovectomy: removing diseased tissue from joints and around tendons to prevent further damage
Joint replacements: particularly the MCP (knuckle) joints to correct the angulation (and appearance) of the joints, improve pain and movement.
Arthrodesis: stiffening badly damaged painful joints to relieve pain and improve function.
Repair of ruptured tendons
Deciding when to operate and what surgery will result in the greatest improvement requires experience and judgement. I have treated patients with RA for many years.
Hand therapy plays an important part in the management of patients with RA. Custom made splints can help control pain and improve hand function. Following surgery, hand therapy is essential to rehabilitate the hand.