Rheumatoid Arthritis (RA) is a chronic autoimmune disease where the body’s immune system attacks its own joint tissues, causing inflammation, pain, and progressive deterioration. Treatment primarily involves medications to control the disease and manage symptoms. However, when conservative therapies are no longer sufficient to prevent joint destruction, surgery may be considered to repair damage and restore function.
When Surgery is Considered for Rheumatoid Arthritis
The decision to proceed with surgery for rheumatoid arthritis is made when other treatments have failed to provide relief or prevent further joint damage. The first line of defense includes:
- Disease-modifying antirheumatic drugs (DMARDs)
- Biologics
- Physical therapy
- Steroid injections
Surgery becomes an option when these measures are no longer effective in controlling pain or halting joint destruction.
Indicators for surgical intervention include severe, ongoing pain that disrupts daily activities, a significant loss of joint function, and joint instability. If a joint has sustained severe damage visible on imaging tests, surgery may be recommended to prevent further complications. The choice to have surgery is a collaborative one, made between the patient, their rheumatologist, and an orthopedic surgeon.
Careful evaluation ensures appropriate timing. Waiting too long could diminish the potential benefits of a surgical procedure, while undergoing surgery too early might be unnecessary if less invasive treatments could still be effective.
Common Surgical Procedures
Several surgical procedures are available to address the joint damage caused by rheumatoid arthritis, with the choice of procedure depending on the specific joint involved and the extent of the damage.
A synovectomy involves the removal of the inflamed joint lining, known as the synovium. This is performed on the wrists, knees, or fingers during the earlier stages of severe joint issues to decrease pain and swelling. While a synovectomy can be effective, the inflamed tissue may grow back, potentially leading to a return of symptoms over several years.
For individuals experiencing ruptured tendons due to chronic inflammation, particularly in the hands and wrists, tendon repair surgery is a solution. The procedure aims to fix the damaged tendons to restore proper movement and function to the affected area.
In cases of severe joint destruction, a procedure called arthrodesis, or joint fusion, may be performed. This surgery involves removing the damaged joint and permanently fusing the adjacent bones together with pins, plates, or rods. Arthrodesis provides stability and pain relief but results in a complete loss of motion in the fused joint. It is most frequently used for smaller joints where movement is less critical, such as those in the ankles, wrists, fingers, and toes.
The most extensive surgical option is arthroplasty, also known as total joint replacement. An orthopedic surgeon removes the damaged, arthritic joint and replaces it with a prosthesis made of metal, plastic, or ceramic. This surgery is performed on large, weight-bearing joints like the knees and hips but can also be applied to shoulders, elbows, and even smaller joints in the fingers.
The Surgical Process and Recovery
The surgical process begins with detailed pre-surgical planning. This phase includes consultations with the rheumatologist and orthopedic surgeon, medical evaluations, and imaging studies to assess joint damage. An important consideration is the management of RA medications, as some drugs may need to be temporarily paused before the operation to lower the risk of post-surgical infection.
Following the procedure, a hospital stay is required, with the length varying based on the type of surgery performed. Post-operative care focuses on managing pain with prescribed medications and preventing complications like blood clots. Patients are encouraged to begin moving soon after surgery, and a sling, splint, or crutches may be used to provide support during the initial healing phase.
Rehabilitation is a part of the recovery process and starts shortly after the operation. A physical therapist designs a personalized exercise program to help regain strength, flexibility, and range of motion in the affected joint. An occupational therapist may also provide guidance on how to adapt daily activities to protect the joint as it heals. The full recovery timeline can range from a few weeks for a minor procedure to several months for a total joint replacement.
Managing Life After Surgery
It is important to understand that surgery is a treatment for a damaged joint, not a cure for the underlying rheumatoid arthritis. After the procedure, individuals will need to continue working with their rheumatologist to manage the systemic autoimmune disease. This ongoing medical care, including taking prescribed RA medications, is necessary to control inflammation and protect other joints from future damage.
While a successful surgery reduces pain and improves the ability to perform daily tasks, there may be some long-term limitations. For example, joint fusion results in a permanent loss of motion in that specific joint. In the case of joint replacement, the artificial joint has a finite lifespan and may eventually wear out, potentially requiring a revision surgery in the future.
Living a full life after surgery requires a continued partnership with the healthcare team. Regular follow-up appointments are needed to monitor the operated joint and manage the overall RA condition. By adhering to rehabilitation plans and ongoing medical treatment, patients can optimize their functional improvements and maintain their quality of life.