The Role of Surgery in Rheumatoid Arthritis

Mr. Chris Khoo, Consultant Surgeon at The Bridge Clinic, Maidenhead
Original article: 21/11/2001
Reviewed: 02/10/2009
Next review due: 02/10/2011

Rheumatoid arthritis is a systemic disease with widespread effects. Whilst it is natural to think of surgery to joints as being the most significant surgical intervention it is in fact soft tissue problems which cause the surgeon most concern - these include, nerve compression syndrome due to inflammation and soft tissue swelling, tendon ruptures and skin problems such as rheumatoid nodules and ulceration. Despite medication healing usually occurs after surgery though chronic ulcers do take their time to respond.

Joint replacement surgery in the hand is indicated when there is pain which does not respond to medical management, progression of deformity, and loss of function. Removal of the inflamed tissue (synovectomy) is often very helpful in not only reducing tense joint swelling but also reducing inflammation and pain. Joints can be realigned, postural deformities corrected, and if necessary joint replacement surgery can be undertaken. In some cases joints are so unstable or so significantly displaced that even a fusion, a procedure to stabilise the joint in a functional position, can improve function dramatically. Of course, many patients have as their chief concern the appearance of the hands. Doctors tend to think of pain relief and functional improvement as being the first priority but nonetheless rheumatoid hand surgery does also bring about an improvement in appearance.

Many hand surgical procedures can be undertaken under local anaesthetic and procedures vary in duration. A carpal tunnel decompression is routinely undertaken as an outpatient procedure under local anaesthetic, and will usually take less than 10 minutes. Multiple joint replacement procedures can be undertaken in the upper limb and deformities in the feet can also be corrected. Specialised orthopaedic surgeons may be consulted if there are spinal or other large joint problems.

It is not always possible to stop progression of the disease, but surgery is a very useful part of a combined approach to control the disease and correct its effect. Physiotherapy and splintage and supervised mobilisation are also very important after any surgical procedure and there is a very good success rate in controlling pain and correcting deformity.

Hand Surgery  - Before Operation

Hand Surgery - After Operation

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