Preoperative and Postoperative Medical Management for Rheumatoid Hand Surgery

Rheumatoid arthritis (RA) is a progressive disease of joint inflammation with systemic and extra-articular features. The evolving understanding of its pathogenesis has led to revolutionary development of targeted therapy that is changing its course and associated morbidity and mortality. Nevertheless, a substantial number of patients will experience progression of their disease leading to disability. Reconstructive hand surgery remains an important complimentary therapeutic option in restoring function and improving quality of life for patients with RA. Preoperative management of the disease and comorbidities is critical in optimizing the surgical outcome. Postoperative wound and joint infections remain a serious concern and can be minimized by reducing the intensity of immunosuppression. A multidisciplinary approach involving the surgeons, rheumatologists, primary care physicians, anesthesiologists, radiologists, and rehabilitation specialist is essential for a successful outcome.