EXPERIENCE OF MULTIDISCIPLINARY TEAM FOR COMPLEX HAND FUNCTION PROBLEMS AT THE RHEUMATOLOGY OUTPATIENT CLINIC OF MODENA

Orthopedic surgery (OS) is an integral part of the total management programme for patients with rheumatic disease (RD). Indication for synovectomies as well reconstructive surgery in RD should be based on a joint decision between the patient, the rheumatologist, the orthopaedic surgeon as well as other health professional. The proposed functional activities of the patients and their own personal goals should be taken into account. Consequently, the package of care should be individual and tailored to the persons identified needs.In 2006 in Academic Hospital of Modena, Italy, at the Rheumatology outpatient clinic a multidisciplinary team has been performed consisting of rheumatologists, hand surgeon, physiatrist, and hand physiotherapist, occupational therapist). Rheumatologists normally are responsible for referring the patients on to others specialists. The team works together to evaluate patients affected by chronic inflammatory diseases (rheumatoid arthritis - RA, spondyloarthropaties - Spa, microcristalline arthropathy) or connective tissue diseases with complex hand function problems.The discussion during the visit and the execution of the various tests have enabled patients to understand functional changes that the disease has caused and has made them more available to use splints or to undergo surgery.At the end of the diagnostic and functional study 19 patients were sent to the surgery (9 synovectomies, 10 reconstructive surgeries) while the others received physiotherapy/rehabilitation appropriate to their needsConclusion: These aspects support a team approach in the planning and performance procedures in patient with rheumatic diseases; ideally, orthopaedic surgeon, physiatrist, and rheumatologist as well as the multidisciplinary team should work together in a functional musculoskeletal unit with a multidisciplinary approach.Patients showed to appreciate this approach.