title: Rheumatoid hand surgery: is there a decline? A 22-year population-based study.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is the most common idiopathic inflammatory arthritis affecting 0.8 % of the population. It can cause significant hand and wrist damage and dysfunction. Recent advances in anti-rheumatic treatments have the potential to decrease the prevalence of hand deformities in patients with RA. Our aim was to investigate whether there has been a decline over 22-years in the number of hand surgical procedures being undertaken for patients with RA and whether this correlates with the introduction of new anti-rheumatic therapies.
  
  
  METHODS
  We performed a retrospective, population-based (Derbyshire) study of all patients with RA who underwent hand surgery at the Pulvertaft Hand Centre from 1990 to 2012. Index procedures included (1) teno-synovectomy and soft tissue procedures, (2) wrist arthrodesis/arthroplasty and (3) finger arthrodesis.
  
  
  RESULTS
  A total of 297 procedures were performed in 153 Derbyshire patients with RA over the 22-year period, with mean age at surgery 59 years (range 24-88 years). The female to male ratio was 2.5:1. The overall trend showed a peak in 2004 and a subsequent decline thereafter. This coincides with an increasing tendency by local rheumatologists to introduce earlier and more intensive conventional disease-modifying drugs and biological therapies for more resistant disease.
  
  
  CONCLUSIONS
  There has been a decline in the number of hand surgery procedures being performed on patients with RA during our 22-year population-based study. It indicates that medical treatments and strategies have been successful at preventing disease progression.
authors.affiliation: Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gogna
authors.affiliation: Department of Trauma and Orthopaedics, Royal Liverpool Hospitals, Prescot St, Liverpool, Merseyside L7 8XP UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Cheung
authors.affiliation: The Pulvertaft Hand Centre, Royal Derby Hospital, Kings Treatment Centre (KTC), Uttoxeter Road, Derby, DE22 3NE UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Arundell
authors.affiliation: Department of Rheumatology, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Deighton
authors.affiliation: The Pulvertaft Hand Centre, Royal Derby Hospital, Kings Treatment Centre (KTC), Uttoxeter Road, Derby, DE22 3NE UK.
authors.forename: Tommy R
authors.initials: TR
authors.lastname: Lindau
keywords: Biological; DMARD; Hand; Rheumatoid arthritis; Wrist