When do you consider referral to hand surgery for management of joint deformity in RA?  

This is individualized to the patient's needs. If a patient is uncomfortable due to pain, quality of life or lack of function due to the deformity, I would arrange a consultation with a hand surgeon. Some patients do get distressed by the cosmetic appearance of the deformities and this is an indicat...

I agree with Dr. @Ware that the decision has to be individualized for each patient. As a rheumatologist, our main goal is to prevent hand (and other) joint deformities, but alas, sometimes the disease takes its course despite our best efforts. Some patients livelihood depends on hand, or wrist funct...