Rheumatoid arthritis is a disease of the synovium (the lining of the joints) that causes symptoms of pain, swelling and stiffness. The hands are often significantly affected. It often comes on relatively early in life, in the 30's or 40's, affecting women more frequently than men.

There is no doubt that new more sophisticated "Disease-modifying drugs' for RA have made a huge difference to the outlook for RA sufferers. Nevertheless, hand surgeons with an active practice in this area will still be referred patients, young women in particular, with extremely painful and damaged wrist joints, which require surgery.

Other joints in the hand, in particular, the joints of the thumb, and the MCP or knuckle joints of the fingers, are often affected by RA, and benefit at times from surgery to either replace or fuse them.

Patients with RA also present with common hand complaints, such as carpal tunnel syndrome or trigger finger. These often need to be dealt with surgically, but in a different way than is customary with non-rheumatoid patients.

Finally, there are other, less common forms of "inflammatory arthritis" - for example, psoriatic arthritis and Systemic Lupus Erythematosus (SLE) - which have their own particular characteristics, of which the hand surgeon must be aware.

Mr. Gidwani is fortunate to work with colleagues in the University Rheumatology department at Guy’s and St Thomas', and has built up significant experience of treating patients with rheumatoid and other inflammatory arthritides.