gms | German Medical Science

Objectives/Interrogation: Improving the treatment of patients with rheumatoid arthritis (RA) of the metacarpophalangeal joint (MCPJ) and proximal interphalangeal joint (PIPJ).

Methods: We have conducted a retrospective study of 14 female patients (aged 22 to 64) with hand RA treated in the period from 2010 to 2017. The rheumatoid process duration was 8 years or more (average 10.5 years). In total, there were affected 17 hands (72 MCPJ and PIPJ). The finger joint damages comprised a) ulnar MCPJ deviation with palmar phalanx subluxations of the "walrus fin" type (48 cases), b) 15 deformities of "boutonniere" type and c) 9 "swan neck" deformities.

All patients indicated significant deterioration in their life quality: weakness of their hand grips, pain when performing hand grips, joint deformities. In 100% of cases, the joint deformities were accompanied by failures of basic finger grips and prominent contractures with movement restriction of more than 60% compared to normal movement.

All patients underwent total synovectomy of the affected MCPJ or PIPJ. The external fixation distraction device was mounted. Fixation and subsequent distraction with finger stabilization was carried out for 5-6 weeks. After removing the external fixation device, the patients worked out their finger movements.

Results and Conclusions: Immediate and long-term (12 months or more after surgery) results were studied in all patients according to DASH disability questionnaire. All patients had an average decrease in DASH points from 116 to 34 points in the end of 6 month after the surgery. After 6 months, we noted that the position of the operated joints had been preserved correctly, the movements in MCPJ and PIPJ were restored up to average 91% and 84% of the norm, respectively. In the long term (1 year after surgery), the correct position of fingers in the affected joints was observed in 65 cases out of 72, and 62 cases (86.1%) observed complete restoration of MCPJ and PIPJ movement amplitude. In one year or more after the operation, according to radiography, there were no cases of progressive destruction in the affected joints. Of the 8 patients observed in period of more than 3 years, the cases of deformity relapse in the operated finger joints have not been registered.

Applying synovectomy to affected joints in combination with distraction method demonstrates high efficiency. This technology allows restoring the correct bone positions and proper movements in the MCPJ and PIPJ, which helps to improve the life quality of patients.