[Surgery of rheumatoid polyarthritis of the upper limb in adults. Review of current data].

In a surgical population of adult patients with incipient rheumatoid arthritis, most often women aged 40 to 50 years, the various clinical pictures are difficult to outline, but they include: dominant involvement of the lower limbs, acroarthritis with essentially distal lesions of the wrists, hands and feet, and rheumatoid arthritis with multiple joint involvement, requiring multiple surgery in the upper and lower limbs. The involvement of the upper limb follows Eiken's phases of evolution, which must be studied along with Larsen's stages in order to accurately define the indications for treatment. Synovectomy is indicated at Larsen's stages II and III, but if instability is already noted, isolates synovectomy, whether chemical or surgical, is not to be used. It is essential to associate surgical synovectomy with a procedure aimed at realigning and stabilizing the joints, especially in the wrists and the fingers. Synovectomy, realignment and stabilization make up 75% of the current surgery of the rheumatoid wrist. At Larsen's stages IV and V, the extent of osteoarticular destruction makes either arthrodesis or arthroplasty necessary. The indications depend on the location of the lesions, and arthrodesis produces excellent results on the metacarpophalangeal joint of the thumb, the distal interphalangeal joints and the wrist. On the other hand, arthroplasty is indicated for the other joints, the mobility of which must be preserved, even more so as the over- and underlying joints are most often affected.