Non-operative

Non-operative management of the rheumatoid patient involves pain management strategies, custom splints, braces or slings, accommodative or assistive devices to aid with daily activities, and crucially recognizing when there is a need for intervention.

Operative

Operative management is directed at the afflicted joint/s. In the hands and wrists, it might be removing the inflamed synovium, debriding the joint osteophytes and re-routing the tendons to prevent their irritation or rupture. Ruptured tendons require reconstruction. End stage disease of the joint almost invariably requires a replacement, that removes the pain and maintains motion.

In the elbow and shoulder end stage rheumatoid disease is equally debilitating, but the results of joint replacement are remarkable in these patients. Complete alleviation of pain and return of functional range of motion in both is the norm.

Postoperative recovery is sometimes a deterrent to the patient due to the perceived long rehabilitation process in elbow or shoulder replacement surgery. However, advancement in our understanding of the mechanics and fixation methods used in elbow replacement for example, result in at least half of patients able to kiss their thumb one week after the operation and say that their pain is significantly improved.

This procedure is also long lasting, with 8 in 10 patients still having their original prosthesis 10 years after the surgery.

Shoulder replacements in patients with end stage arthritic disease has been revolutionized in the last 30 years with the advent of the reverse total shoulder arthroplasty. This allows patients with completely deficient rotator cuffs to have shoulder replacement surgery and achieve good outcomes.