# Current Concepts in the Management of Rheumatoid Hand

## TL;DR

This review discusses the current approaches for managing hand deformities and tendon damage in rheumatoid arthritis patients.

## Contribution

The paper provides an updated overview of conservative and surgical management strategies for rheumatoid hand deformities.

## Key findings

- Conservative treatments like DMARDs are first-line therapies for rheumatoid arthritis.
- Surgical interventions are recommended for severe deformities or treatment-resistant cases.
- Multiple surgical options exist for MCP joint deformities and tendon damage.

## Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by a T cell-driven autoimmune process, which majorly involves the diarthrodial joints. It affects 1% of the US population, and approximately 70% of patients with RA develop pathologies of the hand, especially of the metacarpophalangeal joints (MCP). Furthermore, also the extensor and flexor tendons of the fingers are frequently involved. The first line of treatment should be conservative. Three general classes of drugs are currently available for RA: nonsteroidal anti-inflammatory agents (NSAIDs), corticosteroids, and disease modifying antirheumatic drugs (DMARDs). Encouraging results have been obtained using DMARDs. However, when severe deformities occur or when patients are unresponsive to medical management and injections therapy, surgical intervention should be performed to relieve pain and restore function. Several surgical options have been described for the management of MCP joint deformities, including soft tissue procedures, arthrodesis, and prosthetic replacement. Tendons ruptures are generally managed with tendon transfer surgery, while different surgical procedures are available to treat fingers deformities. The aim of the present review is to report the current knowledge in the management of MCP joint deformities, as well as tendons damage and fingers deformities, in patients with RA.