Dr Stuart Myers

Rheumatoid Arthritis

- Is a form of Inflammatory arthritis

- It is a symmetrical polyarthritis ( effects many joints at once) present for more than 6 weeks . It can effect every organ in the body - not just the skeletal system.

It can cause extreme destruction of joints and tendons if left untreated. Thankfully the medical treatment of Rheumatoid arthritis (R.A.) has improved so greatly over trhe last 30 years.  30 years ago surgery for Rheumatoid arthritis was very common but  is now much less commonly required. There are many typical deformities associated with R.A.

 

It commonly presents in the hand and wrist.

It typically effects the MCP and PIP joints and the wrist. The DIP joints are much less commonly effected ( unlike osteoarthritis)

   

Despite the finger MCP joints here  being dislocated and the fingers being markedly deviated the finger function may be remarkably well preserved.

The wrist is often involved. A very reliable operation in R.A. is to fuse the wrist - ie no movement. It can provide dramatic pain relief and is well tollerated in this condition.

        

A typical pattern is for the carpal bones to slide down the slope of the radius. Here the joint between the radius & ulna is severely effected.

The inflammation of the synovium can be very prominent around tendons and cause severe damage and dysfunction. Here the flexor tenosynovitis is being removed to prevent tendon rupture an relieve pressure off the median nerve. ( Carpal tunnel syndrome)

"teno" = tendon

"syno" = synovium

"itis" = inflammation

"tenosynovitis" = inflammation of the synovium around a tendon.

 

Another example of flexor tenosynovitis.

Rheumatoid Nodules can form on the elbow and in the fingers and thumb. They may be painful and can make it difficult to grasp objects.

       

Some finger deformities are more difficult to manage and surgery is less reliable. 

eg Boutonniere deformity  

 

eg Swan Neck Deformity  

The shape of the finger looks like a Swan's neck. Splints can be used to help control the deformity if it is flexible. If deformity is present for a long enough time the joints may be destroyed and the deformity may become "fixed". At this stage only surgery can correct the deformity.