Should the surgical intervention of the hands and wrists of patients with rheumatoid arthritis be earlier?

Few studies have been published about early surgical treatment of Rheumatoid Arthritis (RA). This article has aimed to describe the main procedures that may be performed in the hands of subjects at early stages of this disease. 

This research was a narrative review seeking comparative works in the Medline, LILACs and EMBASE databases. 

The publications showed good results associated with wrist synovectomy. There was a reduction in pain, greater patient satisfaction, and stabilization of the Larsen score. Synovectomy was indicated in these studies as an alternative procedure after three to four months of unsatisfactory clinical therapy. Another possibility of approaching these patients is the repair or transfer of ruptured tendons. Most studies have described this procedure in patients already with deformities secondary to RA and not in the initial phase of the disease. In this group of patients, the authors observed that the highest number of ruptures was associated with worse surgical outcomes. In most studies about wrists, radiolunate and RA were performed at more advanced stages, such as Larsen 3, and, even performed late, a clinical and radiological improvement was observed. 

In this review, no studies with a high level of scientific evidence, testing early surgical interventions on the hands and wrists of patients with RA were found. Synovectomy, soft tissue repair, and arthrodesis are suggested as procedures that can be performed earlier than usual.