(iv) The management of the rheumatoid wrist

The success of surgical management depends on a well-considered strategy in timing the different procedures. Prophylactic surgery may prevent further destruction and deformation. This includes synovectomy of the tendons in order to prevent attrition rupture, to avoid challenging tendon reconstruction. Together with synovectomy of the wrist, including the distal radio-ulnar joint, long-lasting pain relief can be observed. In later stages of the disease, it is the extent of destruction at the radiocarpal level which has great implications in reconstructive surgery. Possible options are partial joint fusion, combined with an ulnar head resection, total wrist fusion or wrist arthroplasty. In cases of severe destruction, however, definitive stabilization by total wrist fusion is indicated. A pain-free, stable wrist joint often outweighs the disadvantage of the lack of mobility.