The Role of Hand Surgery on Quality of Life and Patient Satisfaction in Rheumatologic Patients

Year 2025, Volume: 78 Issue: 1, 76 - 83, 31.03.2025

Mehmet Yalçın

Abstract

Objectives: Rheumatologic diseases, particularly rheumatoid arthritis (RA), often lead to hand and wrist dysfunction, significantly impairing patients’
quality of life. Despite advancements in pharmacotherapy, deformities, pain, and functional losses persist, necessitating surgical interventions. This
study evaluates the outcomes of hand surgeries in rheumatologic diseases, focusing on functional improvements, pain relief, and patient satisfaction.

Materials and Methods: A retrospective analysis was conducted on 17 patients with confirmed rheumatologic diagnoses, including RA, systemic
lupus erythematosus, scleroderma, and ankylosing spondylitis, who underwent hand surgeries between 2021 and 2024. Functional outcomes were
assessed using the sequential occupational dexterity assessment (SODA) and Duruoz Scale, along with grip strength and pain levels measured using
a visual analog scale (VAS). Complications, postoperative erythrocyte sedimentation rate (ESR), and patient satisfaction were also evaluated.

Results: Soft tissue surgeries (79.2%) were more prevalent than bone surgeries (20.8%). Significant improvements were observed in functional
outcomes (SODA and Duruoz Scores), grip strength, and VAS scores for general and hand-specific pain. However, ESR values remained unchanged,

indicating persistent systemic inflammation. Complications occurred in 23.5% of patients, including infections, tendon adhesions, and recurrence
of deformities. Patient satisfaction scores were moderate, highlighting unmet expectations.

Conclusion: Hand surgeries provide substantial functional and pain-related benefits for patients with rheumatologic diseases, but moderate
satisfaction levels and high complication rates underscore the need for better preoperative counseling, implant accessibility, and multidisciplinary
management. Future studies with larger cohorts are warranted to refine surgical approaches and improve outcomes.

Keywords

Rheumatologic diseases , hand surgery , rheumatoid arthritis , patient satisfaction , functional outcomes

Project Number

-

Romatolojik Hastalarda El Cerrahisinin Yaşam Kalitesi ve Hasta Memnuniyeti Üzerindeki Rolü

Abstract

Amaç: Romatolojik hastalıklar, özellikle romatoid artrit (RA), el ve bilek fonksiyon bozukluğuna yol açarak hastaların yaşam kalitesini olumsuz
etkilemektedir. Farmakoterapideki ilerlemelere rağmen, deformiteler, ağrı ve fonksiyonel kayıplar devam etmekte olup, cerrahi müdahaleleri gerekli
kılmaktadır. Bu çalışma, romatolojik hastalıklarda el cerrahisi işlemlerinin fonksiyonel iyileşme, ağrı hafifletme ve hasta memnuniyeti üzerindeki
etkilerini değerlendirmektedir.

Gereç ve Yöntem: 2021-2024 yılları arasında RA, sistemik lupus eritematozus, skleroderma ve ankilozan spondilit tanılarına sahip ve el cerrahisi
geçiren 17 hasta üzerinde retrospektif bir analiz yapılmıştır. Fonksiyonel sonuçlar, sıralı işlevsel el yeterliliği değerlendirmesi (SODA) ve Duruöz
Ölçeği ile değerlendirilmiş; kavrama gücü ve ağrı seviyeleri görsel analog skala (VAS) ile ölçülmüştür. Komplikasyonlar, ameliyat sonrası eritrosit
sedimentasyon hızı (ESR) ve hasta memnuniyeti de değerlendirilmiştir.

Bulgular: Yumuşak doku cerrahisi işlemleri (%79,2), kemik cerrahisi işlemlerinden (%20,8) daha yaygındı. Fonksiyonel sonuçlar (SODA ve Duruöz
skorları), kavrama gücü ve genel ile el bölgesine özgü ağrı VAS skorlarında anlamlı iyileşmeler gözlenmiştir. Ancak, ESR değerlerinde değişiklik
olmamış ve bu durum sistemik enflamasyonun devam ettiğini göstermiştir. Hastaların %23,5’inde enfeksiyon, tendon yapışmaları ve deformite
nüksü gibi komplikasyonlar görülmüştür. Hasta memnuniyeti puanları ise orta düzeyde olup, karşılanmamış beklentilere işaret etmektedir.

Sonuç: El cerrahisi işlemleri, romatolojik hastalarda fonksiyonel ve ağrıya bağlı önemli faydalar sağlamaktadır; ancak orta düzeyde memnuniyet
oranları ve yüksek komplikasyon oranları, daha iyi ameliyat öncesi danışmanlık, implant erişilebilirliği ve multidisipliner yönetim ihtiyacını
vurgulamaktadır. Daha geniş hasta gruplarıyla yapılacak gelecekteki çalışmalar, cerrahi yaklaşımların iyileştirilmesine ve sonuçların geliştirilmesine
katkı sağlayacaktır.

Keywords

Romatolojik hastalıklar , el cerrahisi , romatoid artrit , hasta memnuniyeti , fonksiyonel sonuçlar

Ethical Statement

The research protocol was approved by the Human Research Ethics Committee of the Ankara University (decision number: İ11-899-24, date: 13.01.2025). Informed Consent: Informed consent was obtained from all patients in accordance with the 1975 Declaration of Helsinki.

Supporting Institution

-

Project Number

-

Thanks

-

References

• 1. Matsuda K, Shiba N, Hiraoka K. New insights into the role of synovial fibroblasts leading to joint destruction in rheumatoid arthritis. Int J Mol Sci. 2023;24:5173.
• 2. Taylor PC. Pain in the joints and beyond; the challenge of rheumatoid arthritis. Lancet Rheumatol. 2023;5:e351-e360.
• 3. Alfirevic A, Pirmohamed M. Pharmacogenetics and pharmacogenomics In: Kumar D, Antonarakis S, editors. Medical and Health Genomics. 1st ed. Academic Press; 2016:121-137.
• 4. van Lankveld W, van’t Pad Bosch P, van der Schaaf D, et al. Evaluating hand surgery in patients with rheumatoid arthritis: Short-term effect on dexterity and pain and its relationship with patient satisfaction. J Hand- Surg Am. 2000;25:921-929.
• 5. Riches PL, Elherik FK, Dolan S, et al. Patient rated outcomes study into the surgical interventions available for the rheumatoid hand and wrist. Arch Orthop Trauma Surg. 2016;136:563-570.
• 6. de la Mata Llord J and Palacios Carvajal J. Rheumatoid arthritis: Are outcomes better with medical or surgical management? Orthopedics. 1998;21:1085-1086.
• 7. Park JW, Hwang JS, Gong HS. Rheumatoid hand surgery in the era of biologic therapy: A rheumatologist-oriented overview. J Rheum Dis. 2021;28:192- 201.
• 8. Momohara S, Yano K, Sakuma Y, et al. Recent orthopedic surgeries aiming to ımprove quality of life for patients with rheumatoid arthritis. J Rheumatol. 2016;43:245-246.
• 9. Ishikawa H. The latest treatment strategy for the rheumatoid hand deformity. J Orthop Sci. 2017;22:583-592.
• 10. Chung KC, Pushman AG. Current concepts in the management of the rheumatoid Hand. J Hand Surg Am. 2011;36:736-747. 11. Alderman AK, Chung KC, Kim HM, et al. Effectiveness of rheumatoid hand surgery: Contrasting perceptions of hand surgeons and rheumatologists. J Hand Surg Am. 2003;28:3-11.
• 12. Duruöz MT, Kasman SA, Öz N, et al. AB1683 Validity and psychometric characteistics of the duruöz hand index in patients with psoriatc arthritis. Ann Rheum Dis. 2023;82(Suppl 1):2079-2080.
• 13. Herren DB. 20 years of rheumatoid hand surgery: What did I learn? Journal of Hand Sur Eur Vol. 2018;43:237-249.
• 14. Pereira DF, Natour J, Ribeiro LHC, et al. Painless and painful synovitis have similar ultrasound and clinical outcomes: one-year cohort study in longstanding rheumatoid arthritis women patients. Clin Exp Rheumatol. 2020;39:621-630.
• 15. Chung KC, Burns PB, Wilgis EFS, et al. A multicenter clinical trial in rheumatoid arthritis comparing silicone metacarpophalangeal joint arthroplasty with medical treatment. J Hand Surg Am. 2009;34:815-823.
• 16. Lempp H, Galloway J, Hughes LD. How to manage patients’ expectations in rheumatoid arthritis treatment. Int J Clin Rheumtol. 2015;10:301-303.
• 17. Klifto KM, Cho BH, Lifchez SD. The management of perioperative ımmunosuppressant medications for rheumatoid arthritis during elective hand surgery. J Hand Surg Am. 2020;45:779.e1-779.e6.
• 18. Waljee J, Zhong L, Baser O, et al. The incidence of upper and lower extremity surgery for rheumatoid arthritis among medicare beneficiaries. J Bone Joint Surg Am. 2015;97:403-410.
• 19. Gamal SM, Eleishi HH, Moghazy A, et al. Effect of education on disease activity and functional status in rheumatoid arthritis patients. The Egyptian Rheumatologist. 2021;43:7-11.