» Treatment of the patient with rheumatoid arthritis affecting the hand and wrist can be a challenging endeavor. Optimal management for best outcomes includes careful collaboration between providers managing the medical treatment of the disease, therapists, hand surgeons, and the patient. » In this review, we present a challenging clinical scenario with input from key voices from various medical fields to provide a balanced and unbiased diagnosis and treatment recommendation for a patient with complex rheumatoid pathology affecting her hand and wrist.