About 30% of patients with rheumatic hands need to undergo surgery because currently available pharmacological treatments do not achieve good control of the disease.

In the opinion of Dr. Fernando del Canto, deputy physician of the Traumatology and Orthopedic Surgery Service of the Marqués de Valdecilla University Hospital of Santander, with this type of surgery the patient's clinical situation can be improved.

Rheumatoid arthritis (RA) is a chronic disease, which can occur at any age, and causes inflammation of the surrounding joints and tissues. However, it is still often confused with other rheumatic diseases and remains largely unknown to most of the population, despite the fact that it has an incidence of 0.5%. In Spain it is estimated that there is 200,000 affected and that 20,000 new cases are diagnosed every year.

70% of patients with rheumatoid arthritis have involvement of the hand since the beginning of the disease, with symptoms such as pain, rigidity and swelling. As Dr. Del Canto explains, if the medical treatment fails to control the inflammation, it can originate joint deformities hand, causing different degrees of disability, and in some cases may even appear complications such as rupture of tendons or joint destruction.

Surgery, according to this specialist, can serve as adjuvant treatment, although always associated with an adequate control of the disease with drugs. In some cases, in addition, surgical techniques contribute to increase the degree of functional capacity of a patient, although pharmacological therapy is proving effective in controlling arthritis. In those affected who have already suffered certain complications, such as a ruptured tendon, surgery is often the only possibility for them to regain some degree of function.

Preventive surgery and reconstructive surgery

The most outstanding novelties in the field of hand surgery, says Dr. Del Canto, are the advances that have occurred in the design of some prosthetic implants, and the development of arthroscopic techniques, which facilitate certain interventions that previously They were too aggressive for the patient.

Preventive surgery aims to avoid the appearance of possible complications, and its main objectives are to relieve pain, improve function and correct deformities

The specialist adds that preventive surgery is the one of choice because it aims to avoid the appearance of possible complications, and its fundamental objectives are to relieve pain, improve function and correct deformities.

When the patient has already suffered some complication and it is necessary to solve it, they resort to palliative surgeries, which are more complex, have lower functional expectations, and their results are not as good. These techniques include tendon repairs, surgery on the distal radio-ulnar joint, arthroplasty and arthrodesis.

In any case, and as this specialist recalls, it is a chronic disease, so the patient needs a medical treatment continued and under the medical control of his rheumatologist, and also the surgeon in the case of having undergone a prosthetic implant .

Source: Spanish Society of Rheumatology (SER)

RA Patients Regain Their Footing (November 2019).