[Tendon diseases in chronic rheumatoid arthritis]

Rheumatoid arthritis is basically a disease of the synovium and involves the synovium-lined sheaths that surround many of the tendons in the hand and wrist. Proliferative synovitis affects the tendons, infiltrates the tendons, causes formation of nodules, changes their ultrastructure, and eventually leads to spontaneous rupture. The three common sites of tendon sheath involvement are the dorsal and palmar aspect of the wrist, and the palmar aspect of the digits. Early tenosynovectomy can prevent tendon ruptures and should therefore be the cornerstone of treatment. Once spontaneous rupture has occurred, early diagnosis and treatment are important to prevent further rupture. Reconstruction of isolated ruptures of extensor or flexor tendons gives good results. Multiple tendon ruptures, however, are difficult to treat and have a worse prognosis. The severity of the patient's disease and the degree of articular involvement have a greater effect on the outcome of surgery than reconstruction techniques. Our current approach to the management of this difficult problem is presented.