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Surgery Insight: orthopedic treatment options in rheumatoid arthritis

Nature Clinical Practice Rheumatology volume 4, pages 266–273 (2008)Cite this article

Abstract

Longstanding rheumatoid arthritis (RA) leads to disability, caused mainly by joint destruction. The current goals of surgical intervention are to restore function and quality of life, prevent joint deterioration, relieve pain, and correct deformity. A number of different surgical treatment options are available to patients with RA, including synovectomy, arthrodesis, joint replacement, and soft tissue and special hand surgery; nonoperative management is also important. Decision-making and timing for orthopedic intervention are complex issues because of polyarticular involvement. Functional impairment, pain, and the subsequent loss of quality of life and inability to work have become the main considerations for surgical reconstruction. Early referral for orthopedic treatment can lead to improved functional benefit for patients with RA. The decision for orthopedic intervention should be established by an interdisciplinary team that includes rheumatologists and orthopedic surgeons experienced in the surgery of RA. Priority should be given to the joint that causes the greatest disability and pain. Disease progression and pharmaceutical treatment options should be taken into consideration when establishing an orthopedic intervention protocol.

Key Points

  • Functional impairment, pain, and the subsequent loss of quality of life and inability to work are main considerations for surgical reconstruction in patients with rheumatoid arthritis

  • Early referral for orthopedic treatment can result in greater functional benefit

  • The decision for orthopedic intervention should be established by an interdisciplinary team that includes rheumatologists and orthopedic surgeons who are experienced in the surgery of patients with rheumatoid arthritis

  • Priority for surgery should be given to the joint that causes the greatest disability and pain

  • Disease progression and pharmaceutical treatment options should be taken into consideration when establishing an orthopedic intervention protocol

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Figure 1: Overview of the main surgical treatment options available to patients with rheumatoid arthritis.
Figure 2: Examples of prosthetic treatment options available for patients with rheumatoid arthritis in the shoulder.

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Acknowledgements

The program leading to the article was funded by the Georg and Bertha Schwyzer-Winiker foundation. The authors thank D Gross for assistance with preparation of the manuscript.

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Authors and Affiliations

  1. BR Simmen is the Chairman and J Goldhahn is a Senior Researcher at the Upper Extremity Department of the Schulthess Klinik in Zürich, Switzerland.,

    Beat R Simmen

  2. ER Bogoch is an Orthopedic Surgeon in the Department of Surgery and Medical Director of the Mobility Program at St Michael's Hospital, Toronto,

    Earl R Bogoch

  3. J Goldhahn is a Professor in the Department of Surgery at the University of Toronto, Toronto, Canada.,

    Jörg Goldhahn

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  1. Beat R Simmen
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Correspondence to Jörg Goldhahn.

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Simmen, B., Bogoch, E. & Goldhahn, J. Surgery Insight: orthopedic treatment options in rheumatoid arthritis. Nat Rev Rheumatol 4, 266–273 (2008). https://doi.org/10.1038/ncprheum0767

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