Rheumatoid arthritis results in characteristic deformities of the hand. Medical treatment has undergone a remarkable development. However, not all patients achieve remission or tolerate the treatment. Patients who suffer from deformities and persistent synovitis may be candidates for hand surgery, for which the main goals are pain relief and improved function. Surgical interventions can be divided into prophylactic and therapeutic procedures. The treatment strategy is individual and depends on close collaboration between rheumatologists, hand surgeons and patients.