Are DMARDs enough to prevent surgery in rheumatoid hands?

The hands are commonly involved in RA Rheumatoid arthritis (RA) is a chronic, auto-immune disorder characterised by inflammation primarily in the joints. The small joints in the hands are typically involved in RA, with both the 1987 American Rheumatism Association revised criteria for RA classification including “arthritis of hand joints” as one of the criterion [1] and the 2010 RA classification criteria awarding more points for small joint involvement (i.e. themetacarpophalangeal joints, proximal interphalangeal joints, second to fifth metatarsophalangeal joints, thumb interphalangeal joints and wrists) [2]. RA is the most common of the inflammatory arthritides; a study in the UK found the prevalence of RA to be 1.16% in women and 0.44% in men [3]. In Asia, the prevalence of RA varies from country to country. In rural areas, the prevalence of RA is 0.12% in Thailand, 0.2% in Indonesia, 0.26% in Taiwan, 0.3% in Malaysia, 0.34% in China, 0.55% in India and 0.7% in Bangladesh [4].