<p>Rheumatoid arthritis (RA) is a&#xa0;chronic inflammatory, immune-mediated disease of the musculoskeletal system that predominantly affects the hands and feet. The introduction of highly potent biologic disease-modifying drugs (bDMARDs) has led to a&#xa0;reduction in severe joint destruction and surgical interventions over the last two decades. Nevertheless, hand surgery remains an essential component of interdisciplinary therapy. Joint-preserving measures such as selective arthroplasty and partial arthrodesis are increasingly being performed today instead of arthrodesis, which was more common in the past. At the same time, the perioperative management of biologics is individually adapted to minimize the risk of infection. The following article draws on more than 30&#xa0;years of personal experience in the treatment of patients with underlying rheumatic diseases and discusses current treatment recommendations for the hand and wrist.</p>