Hand Surgery in Rheumatoid Arthritis (RA) | PAX Medicus Medical Tourism UK

Hand Surgery in Rheumatoid Arthritis (RA)

Rheumatoid Arthritis (RA) is a chronic autoimmune disease that affects joints throughout the body. When it involves the hands, it can lead to pain, stiffness, tendon damage and progressive deformities that affect daily function. Hand surgery is used to restore comfort, mobility and independence.

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What is Rheumatoid Arthritis (RA)?

Rheumatoid Arthritis (RA) is a systemic connective tissue disease that is chronic, inflammatory and progressive. It is classified as an autoimmune disorder, meaning that the immune system mistakenly attacks the body’s own cells, treating them as foreign. The exact cause is not fully known, but RA is believed to be multifactorial.

A family history increases risk, with identical twins showing up to a 50% likelihood of both developing RA. Possible triggers include viral or bacterial infections, significant stress, and smoking. RA is more common in women and usually begins after the age of 35.

General symptoms

  • Fatigue and poor sleep
  • Muscle aches and general malaise
  • Reduced appetite or mild weight loss
  • Low-grade fever

Joint-specific symptoms

  • Morning stiffness
  • Pain after rest (e.g. sitting, lying down)
  • Symmetrical involvement of joints
  • Progressive ligament and tendon damage

RA also affects the entire body, increasing the risk of cardiovascular disease, vasculitis, osteoporosis, pneumonia, kidney dysfunction and Sjögren’s syndrome (dry eyes described as “grit under the eyelids”).

How is RA treated non-surgically?

RA management requires a coordinated, multidisciplinary approach. A rheumatologist manages medications, while physiotherapy and lifestyle adjustments are essential for maintaining mobility and reducing pain.

Medication

  • DMARDs (disease-modifying antirheumatic drugs)
  • Biological therapies (e.g. infliximab, rituximab)
  • Methotrexate and sulfasalazine
  • Glucocorticosteroids (short-term use)
  • NSAIDs for pain and inflammation

Lifestyle & rehabilitation

  • Physiotherapy and structured exercises
  • Psychological support
  • Balanced, calcium-rich diet
  • Braces and orthopaedic supports when advised
  • Walking aids for mobility difficulty
  • Smoking cessation

Surgical treatment options

  • Synovectomy: removal of diseased synovial tissue to reduce inflammation
  • Tenosynovectomy: removal of pathological tendon sheaths to prevent rupture
  • Tendon transfers: rerouting tendons to restore balance and prevent deformity
  • Distal ulna resection: improves wrist rotation when the radioulnar joint is damaged

  • Joint replacement: using metal or silicone implants
  • Capsule reconstruction: restoring stability of damaged joints
  • Tendon repositioning and repair
  • Arthrodesis (joint fusion): stabilises severely damaged joints
  • Total wrist arthroplasty: restores mobility while reducing pain
  • Side-to-side tendon stitching: used when tendon damage is extensive

Surgery usually follows a structured order, beginning with the wrist before addressing deformities in the fingers.

What is a rheumatoid hand?

A “rheumatoid hand” describes the deformities caused by RA. Progressive damage to the wrist and finger joints leads to reduced mobility, abnormal positioning, swelling and impaired hand function.

Common deformities

  • Wrist subluxation – partial dislocation of the ulnar head
  • Ulnar deviation – fingers drift towards the little finger side
  • Boutonnière deformity – PIP flexion, DIP hyperextension
  • Swan neck deformity – PIP hyperextension, DIP flexion
  • Mallet finger – drooping fingertip from extensor tendon rupture

Why deformities occur

  • Chronic inflammation damaging ligaments
  • Tendon rupture or stretching
  • Joint erosion and instability
  • Muscle imbalance around affected joints
  • Structural collapse of the metacarpal bones

Recovery after RA hand surgery

Recovery depends on the complexity of surgery, the degree of joint damage and the patient’s overall health. Surgery is only one part of RA management — long-term success requires medication, physiotherapy and lifestyle adjustments.

Post-surgery expectations

  • Recovery times vary depending on the procedure
  • Pain, swelling and stiffness gradually improve
  • Physiotherapy is essential for regaining movement
  • Hand function improves progressively over months

Long-term care

  • RA is incurable, but symptoms can be controlled
  • Consistent use of prescribed medication is critical
  • Regular follow-up with a rheumatologist
  • Healthy diet and physical activity recommended
  • Smoking cessation significantly improves outcomes

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