The latest treatment strategy for the rheumatoid hand deformity.

Abstract

With a remarkable improvement in the pharmacotherapy of rheumatoid arthritis (RA), severely handicapped patients are very rare to see. Healing, repair and drug-free, and toward radical cure are coming to be possible. In the clinical practice, more than 50% of the patients are in remission. However, some patients are still difficult to reach remission due to comorbidities and economic burden. In the patient with clinical remission, smoldering synovitis so called "silent destructor" is often detected by ultrasonograpy or by synovial histology in the small joints of the hand. In recent years, over use with "no pain" increases the risk of deformity, osteoarthrosis, tendon rupture and entrapment neuropathy. Highly motivated patients, who concern about the appearance of the hand, hope to get a higher level of activities of daily living and quality of life (QOL). A prospective cohort study was performed for the purpose of knowing whether rheumatoid hand surgery affects the patient's QOL and mental health as well as upper extremity function. A primary hand surgery was scheduled in 119 patients with RA. Synovectomy and Darrach procedure, radiolunate arthrodesis, reconstruction of the extensor tendons, arthroplasty at the metacarpophalangeal (MP) using Swanson implant, fusion at the proximal interphalangeal (PIP) joint, suspensionplasty at the carpometacarpal (CM) joint of the thumb (Thompson method) etal. were performed. As a result, Japanese version of the Stanford Health Assessment Questionnaire (J-HAQ:physical function,QOL), EuroQOL-5 dimension (EQ-5D:QOL), Beck Depression Inventory-II (BDI-II:depression, mentality) at 6 months and at 12 months after surgery improved significantly compared to those just before surgery (p<0.01). Disease activity score 28- C reactive protein 4 (DAS28-CRP (4)) decreased significantly (p<0.01). Latest hand surgery with tight medical control is possible to raise QOL and to provide mental wellness for the patient with RA.