The rheumatoid hand: a review of current medical and surgical management

Abstract

Rheumatoid arthritis is a chronic inflammatory condition in which immunologically mediated inflammation results in marked synovial joint destruction and functional deterioration in addition to often significant systemic disease. It affects approximately 1% of the population according to the UK National Institute for Health and Care Excellence, presents most commonly in women aged 30–50 years, and has a multifocal aetiology including genetic hormonal and environmental factors. Management of rheumatoid hand disease can be complex and involves excellent multidisciplinary team management from the outset. Early treatment with newer rheumatological biologic drug therapy has largely negated the need for surgical management, however there remains several critical opportunities for hand surgeons to improve quality of life for these patients, including emergencies such as impending tendon rupture and nerve compression, as well as function restoring soft tissue and bony procedures. This article seeks to review the complete management of the patient with rheumatoid hand disease, including medical and surgical. A summary of key learning points for colleagues not specifically involved in this practice, such as biologic drug mechanism of action and key biomechanics where relevant is included.