General surgical principles in rheumatoid arthritis: priorities

The treatment of rheumatoid arthritis depends on a team effort, and the medical team should be led by a rheumatologist. The condition is systemic and the treatment is conservative. Surgery is but an episode in the overall treatment. There should be a therapeutic plan with priorities determined by progression from general to specific considerations. To illustrate general principles the author likens rheumatoid arthritis to a house on fire. Specific problems in treating rheumatoid arthritis are the uncertain prognosis in individual cases and the time taken to establish the progressive nature of the changes or the degree of subjective difficulty that may force surgical measures. Patient motivation is important. This is determined by internal and external forces--personality, social, family and financial factors. The patient's goals and desires must be considered in the light of the possibilities and complications of operation as well as the prognosis when operation is not performed.