The hand and wrist in rheumatoid arthritis and osteoarthritis

The approach to patients who suffer from osteoarthritis (OA) and those with rheumatoid arthritis (RA) is very different. Both patients with hand and wrist problems present with pain and commonly loss of function, but the polyarthritis in RA is only one feature of a systemic auto-immune disease. Over the last few years, significant advances in the biologic treatment of RA have modified its natural history. As a result, the amount of rheumatoid surgery being performed has decreased. As an orthopaedic surgeon, it is important to understand the pathogenesis of both of these diseases and the non-operative and operative treatments available. In RA, traditional procedures such as synovectomy have decreased, while the number of arthroplasties has increased in the hope of preservation of movement. In OA, there has also been an increase in small joint and wrist arthroplasty, but with varying short-term results and the long-term outcome of these interventions is awaited.