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Early Surgery May Be Needed For Rheumatoid Arthritis

Rheumatoid arthritis (RA) affecting the wrist is common. Surgery is advised when medical treatment doesn't stop the progression of the disease. The goals are to reduce pain, save wrist function, and prevent deformity. In this article doctors from Canada review the early surgical management of wrist RA.

Two-thirds of all patients with RA have wrist symptoms in the first two years. This number increases to 90 percent by 10 years. The joint, tendons, and cartilage can all be affected. Bone erosion and thinning of the tendons occurs. The bones in the wrist shift and sometimes even rotate and collapse. Joints often dislocate. The tendons may rupture.

Surgery to repair tendons, replace joints, or fuse the wrist may be needed. Surgery can even be done to prevent tendon rupture. This is called prophylactic surgery. The authors say it's best to do as much as possible during each operation. Early surgical intervention can prevent further tendon rupture and prevent disability.

Each of the surgical procedures is reviewed. The authors offer other surgeons their ideas about when and how to do each one. They admit that early surgical treatment is still a highly debated topic. They feel that the short-term benefits are worth it to the patient even if the disease process isn't stopped in the long run.

References: Steven R. Papp, MD, MSc, FRCSC, et al. The Rheumatoid Wrist. In Journal of the American Academy of Orthopaedic Surgeons. February 2006. Vol. 14. No. 2. Pp. 65-77.

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