Table 8.6Indications for RA joint surgery – patients

StudyPatients’ opinionPatientsIndications
1 cross-sectional study370,371Willingness to have surgeryMen and women (NS difference)Main concern: hand pain followed by hand function
Some concern: hand appearance
Concerns of inconveniences, pain, risk of anaesthesia and surgical complicationsWomen and menWomen more concerned than men
1 cross-sectional study372Choosing MCP arthroplastyAll patientsAssociations: age (patients older than 50 years) and gender (female patients more likely).
Predictors: function followed by pain
Not predictor: aesthetic consideration
1 cross-sectional study373Probability of undergoing surgeryAll patientsHighest (univariate): female patients, younger patients, those with long-term disease, a poor functional ability, persistent active disease despite treatment, RF+ and presence of extraarticular complications and significant comorbidity

Highest (multivariate): female gender, long-term disease (≥ 10 years), ACR functional grade III/IV and the presence of extraarticular complications
Probability of undergoing TJRAll patientsHighest (univariate): female patients, those with long-term disease, functional class III/IV, persistent active disease despite treatment, presence of extraarticular complications and/or significant comorbidity

Highest (multivariate): long-term disease (≥ 10 years), ACR functional grade III/IV and the presence of extraarticular complications
1 cross-sectional study374Hopes of what surgery will doAll patientsImproving appearance and function (44%), reducing pain (27%) and improving strength (15%)
Important aspectsAll patientsAbility to perform everyday activities (75%), improvement of hand weakness (73%), ability to do one’s normal work (71%), reduction in hand (50%) and improvement of hand appearance (35%)
What bothered patients most (hand RA)All patientsFunction, pain, appearance and weakness
Patients who chose to have surgeryInability to work or do things with their hands
Patients who chose not to have surgeryHand weakness and appearance
Patients’ post- operative expectationsPatients who chose to have surgery vs not have surgerySurgery patients less likely to expect difficulty with post-operative rehabilitation; NS for belief in chance of post-op complications
Patients’ expectations for status 1 year into the futurePatients who chose to have surgery vs not have surgerySurgery patients more likely to expect the ability to do more with their hands in 1 year, to do more of their work, have les pain and improved hand appearance
Most important person to influence surgical decisionPatients who chose to have surgery vs not have surgeryNS difference. However non-surgical patients valued their own opinion as moist important and surgical valued expert opinion more
1 case-series375Patients with rheumatoid cervical myelopathy who underwent surgery vs conservative treatmentSymptoms present (more): paraesthesia, weakness, unsteadiness, and to exhibit extensor plantar reflexes, gait disturbances and reduced power; Ranawat grades II (NS) or III (SS) and not have normal examination findings (SS)
MRI findings (more likely present): cord compression and impingement on cord.
Less likely present: cervical spondylosis; abnormal neurological findings (but no compression or impingement)

From: 8, Monitoring rheumatoid arthritis

Cover of Rheumatoid Arthritis
Rheumatoid Arthritis: National Clinical Guideline for Management and Treatment in Adults.
NICE Clinical Guidelines, No. 79.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2009, Royal College of Physicians of London.

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