Few patients with rheumatoid arthritis present isolated acromelic bone and joint destruction. The joints concerned are the wrist, MP, PIP, DIP and the forefoot. The aim of the current study was to describe and evaluate the long-term results of wrist, hand, and forefoot surgery in an acromelic arthritis group.

Ninety-three patients with acromelic arthritis were included in the study. Between 1981 and 2001, 202 surgical procedures were performed in addition to medical treatment; 93 procedures concerned dorsal wrist surgery. The mean follow-up of this group was 7 years (range, 24 months to 20 years). Seventy-eight synovectomies of radiocarpal and mediocarpal joints with a Sauvé-Kapandji procedure were performed, ten with a radiolunate arthrodesis, and five with other surgeries. The main indication for surgery was severe pain.

Functional results and radiographic progression (Larsen x-ray classification) were studied. All patients were satisfied or very satisfied, and pain was significantly reduced. Radiographic lesions progressed but Larsen's stage remained unchanged in 73% of patients. All patients with forefoot surgery recovered total walk autonomy.

Acromelic arthritis is a particular form of rheumatoid arthritis that progresses very slowly. Surgery should be indicated earlier, for better joint function stabilization.