Surgical and Medical Procedures for Rheumatoid Arthritis
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Medical Procedures
If medications and other comfort measures are ineffective, there are some invasive procedures that are used to temporarily reduce joint pain and inflammation. These procedures will have to be repeated to maintain effectiveness.

Intra-articular Corticosteroid Injections
Corticosteroids can be directly injected into the joint with a needle. Steroids can help decrease inflammation and pain in the joint. Sometimes, your doctor will remove excess joint fluid from the joint just before injecting the steroid medication.

Steroid injections often have to be repeated every several months. Most practitioners believe that you shouldn’t get more than 3-4 such injections in a year. More injections may cause damage to the joint cartilage.

Apheresis (Prosorba Column)
This is a treatment that involves filtering your blood through a medical device that removes antibodies. The rest of the blood is then returned to you. The procedure takes about 2 hours and is usually done weekly for 12 weeks. Side effects may include:

  • Fatigue
  • Achy muscles
  • Weakness
  • Joint pain and swelling
  • Nausea
Surgical Procedures
Surgery can not treat rheumatoid arthritis (RA) itself, but may be needed to repair, rebuild, or replace damaged joints and supporting structures. It may help to reduce or eliminate pain, correct joint deformities, and restore mobility. Surgical procedures are generally only recommended for those who don't have relief with other treatment methods.

Tendon Reconstruction
Chronic inflammation of RA can cause damage to tendons near the affected joints. Damaged tendons can make it difficult to move since tendons connect muscles to bone. Severe damage to the tendon can also lead to a rupture of the tendon. Surgery may be recommended if the tendon pain is not responding to conservative treatment or is interfering with daily activities.

A tendon reconstruction surgery will repair or replace damaged tendons with new tendon tissue. It is most often done on tendons of the hands.

Metatarsal Head Resection
RA can cause a deformity of the joints. Deformity in the feet can be painful and make it difficult to walk.

The metatarsal heads are the end of toe bones that make up the joints at the ball of the foot. A metatarsal head resection removes and remodels the metatarsal head to reduce deformity, improve function, and reduce pain.

Synovectomy
The synovium is the tissue that surrounds the joint. Inflammation from RA develops in this tissue.

A synovectomy is the removal of the inflamed synovium. It is rarely done since the tissue will eventually grow back but it may be done with other surgical repairs. A synovectomy may provide temporary pain relief and slow the destruction of the joint.

Arthroplasty
Arthroplasty replaces part or all of the damaged joint. A synthetic joint or devices, often made of a chromium alloy and plastic, will be used. The replacement is done to decrease pain and improve function.

The knee and hip are the most common joints replaced.

Hip Replacement

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Arthrodesis
Arthrodesis is a last resort for those who have not had good pain relief from other efforts. In this procedure, the two bones making up a joint are permanently fused together. While this can greatly improve pain, it also means that the joint is no longer able to function and movement is limited.




References:
Handout on health: Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp. Updated August 2014. Accessed October 31, 2014.

Rheumatoid arthritis. Arthritis Foundation website. Available at: http://www.arthritis.org/conditions-treatments/disease-center/rheumatoid-arthritis. October 31, 2014.

Rheumatoid arthritis. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/joint_disorders/rheumatoid_arthritis_ra.html. Updated May 2013. Accessed October 31, 2014.

Rheumatoid arthritis (RA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 10, 2014. Accessed October 31, 2014.

Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011;84(11):1245-1252.

Last Reviewed May 2014



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