Rheumatoid Arthritis – Surgery

What we will see

• Diagnostic difficulties
• Patients with a diagnosis of Rheumatoid arthritis who are having functional issues with their hands
• Pain unresponsive to simple non-interventional measures

What we won’t see

• Straightforward diagnosis with no functional deficit

Specific tests

• Clinical examination of joint – palpation, range of movement
• X-ray of affected part (be specific about digit and joint on request)

Trial of therapy pre-referral

• If no functional deficit then no treatment required
• Trial of oral analgesia or topical NSAID gel
• Activity modification
• Consider appropriate splintage

Whom to direct referral to

• Any hand surgeon

• Plastic Surg – PIL BSSH CARPAL TUNNEL Aug18
• Plastic Surg – PIL BSSH GANGLIA Aug18
• Plastic Surg – PIL BSSH OA THUMB Aug18
• Plastic Surg – PIL BSSH TRIGGER FINGERAug18
• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Wrist Pain Algorithm of Differential Diagnoses