La muñeca reumatoidea. Aspectos esenciales en el tratamiento

Abstract

IntroductionWrist involvement is common in patients with rheumatoid arthritis.Patients with persistent pain and swelling despite medical therapy are candidates for surgery.The aim of this paper is to describe medical aspects and indications and types of surgeries in a rheumatoid wrist. Materials and methodsThe keywords chosen in Spanish and English were rheumatoid hand or wrist, rheumatoid arthritis and hand or wrist rheumatoid arthritis, radiosynovectomy in rheumatoid arthritis or arthritis. Finally 52 articles were selected. ResultsWhen there is not good response to medical treatment before going to surgery, local infiltration of corticosteroids and radiosynovectomy can be used.The synovectomy and tenosynovectomy give symptomatic relief and improve function in the short term. Extensor and flexor tendons may rupture due to synovial infiltration and irritation caused by bone prominences, such as ulnar head subluxation.When tendon ruptures occur, tendon grafts or tendon transfers are the solution. Carpal instability, severe arthritis and joint damage often require stabilization surgery on the bones.The distal radioulnar joint often initially affected, procedures like Sauvé-Kapandji technique or Darrach go great in this joint.The partial arthrodesis radio-carpal offers stability in the involved joint, respecting and preserving in the medio-carpal joint some mobility. When there is already a global osteoarthritis, total wrist fusion provides good results in relieving pain and stability.Total wrist arthroplasty is an alternative that preserves the movement; however the long-term results remain to be seen.