Surgical management

Methods include:

• tendon repair or transfer to prevent progressive deformity secondary to tendon rupture and joint instability
• reconstructive surgery for advanced joint destruction, instability and deformity
• synovectomy
• arthrodesis, osteotomy, joint replacement and excision arthroplasty are also used

Timing and referral for surgery

• offer to refer people with RA for an early specialist surgical opinion if any of the following do not respond to optimal non-surgical management:
  • persistent pain due to joint damage or other identifiable soft tissue cause
  • worsening joint function
  • progressive deformity
  • persistent localised synovitis
• offer to refer people with any of the following complications for a specialist surgical opinion before damage or deformity becomes irreversible:
  • imminent or actual tendon rupture
  • nerve compression (for example, carpal tunnel syndrome)
  • stress fracture
• offer urgent combined medical and surgical management to people with RA who have suspected or proven septic arthritis (especially in a prosthetic joint)
• if a person with RA develops any symptoms or signs that suggest cervical myelopathy :
  • request an urgent MRI scan, and
  • refer for a specialist surgical opinion
• do not let concerns about the long-term durability of prosthetic joints influence decisions to offer joint replacements to younger people with RA

Reference:

• 1. NICE (July 2018). Rheumatoid arthritis- The management of rheumatoid arthritis in adults