ਇਨਫਲਾਮੇਟਰੀ ਅਤੇ ਰੀਊਮੈਟੋਇਡ ਆਰਥਰਾਈਟਿਸ ਜਾਣਕਾਰੀ

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• The volume of total joint arthroplasty procedures in patients with rheumatoid arthritis has trended markedly upward over the past decade, with a sharp increase after 2015 [1].
• Inflammatory arthritis is associated with higher rates of medical and surgical complications compared to osteoarthritis in patients undergoing anatomic or reverse total shoulder arthroplasty [9].
• Following total shoulder arthroplasty, patients with rheumatoid arthritis are at higher risk of systemic and joint-related complications compared to patients with primary osteoarthritis [5].
• Despite comparable complication rates between rheumatoid arthritis and non-rheumatoid arthritis cohorts, rheumatoid arthritis patients have increased revision rates in total elbow arthroplasty [2].
• Following primary total hip arthroplasty, patients with rheumatoid arthritis can expect reduced pain and improved functional outcomes similar to those with osteoarthritis [6].
• Patients with rheumatoid arthritis undergoing primary total hip arthroplasty may be at an increased risk of complications and revision surgery [6].
• In the largest single-institution study to date, patients with rheumatoid arthritis reported poorer patient-reported outcome scores compared with osteoarthritis and posttraumatic arthritis groups after total ankle arthroplasty [7].
• Patients with rheumatoid arthritis experienced functional outcome improvement from the preoperative baseline following total ankle arthroplasty [7].
• Denosumab demonstrates promising efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis [3].
• Cutaneous psoriasis and psoriatic arthritis are associated with higher rates of infections and all-cause revisions following total hip arthroplasty [13].

Background & Causes

• Patients with rheumatoid arthritis undergoing elective hand surgery who continue perioperative biologic disease-modifying antirheumatic drugs do not experience significant increases in risks of wound healing failures or surgical site infections [15].
• Discontinuation of antiviral prophylaxis correlates with a high prevalence of hepatitis B virus reactivation in rheumatoid arthritis patients with a hepatitis B virus carrier state [17].
• Preclinical evidence supports an antioxidant, anti-inflammatory, antinociceptive, cartilage- and bone-protective effect of calcitonin in rheumatoid arthritis and osteoarthritis [16].
• Tectochrysin may act as a novel rheumatoid arthritis therapeutic agent via macrophage JAK/STAT pathway inhibition [14].

Symptoms & Presentation

• Patients with rheumatoid arthritis who have undergone shoulder arthroplasty experience reduced pain and improved function [10].
• In patients with rheumatoid arthritis, negative affect moderates pain following shoulder arthroplasty [10].
• Patients with rheumatoid arthritis report poorer patient-reported outcome scores compared with osteoarthritis and posttraumatic arthritis groups following total ankle arthroplasty [7].
• Patients with rheumatoid arthritis experience functional outcome improvement from the preoperative baseline following total ankle arthroplasty [7].
• Total knee arthroplasty in patients with rheumatoid arthritis yields significant improvement in physician- and patient-reported outcomes [12].
• Patients with rheumatoid arthritis can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty [6].
• Patient-reported functional outcomes at 6 months following total elbow arthroplasty were significantly lower in the fracture group compared to osteoarthritis and rheumatoid arthritis groups [11].
• The Kudo type-5 prosthesis demonstrated satisfactory results in patients with rheumatoid arthritis over a minimum 10-year follow-up period [18].
• Failures of the Kudo type-5 prosthesis occurred to some extent over a long-term follow-up period in patients with rheumatoid arthritis [18].
• HandScan optical imaging can reliably identify ultrasound-defined remission in rheumatoid arthritis at the joint level with good sensitivity and high positive predictive value [21].
• DAS-OST can determine ultrasound remission in rheumatoid arthritis at the patient level but with lower performance than HandScan [21].

Management

Non-Operative

• Rheumatoid arthritis is a chronic, systemic, inflammatory disease that most often involves the small joints of the hands and feet, although any synovial joint can be affected [19].
• Rheumatoid arthritis affects 1% to 2% of the world population, with a female-to-male ratio of 2.5:1 [19].
• Adult rheumatoid arthritis is usually polyarticular, while systemic involvement in visceral organs or eyes is rare [19].
• The test for rheumatoid factor in adults is positive in 70% to 80% of patients diagnosed with rheumatoid arthritis [19].
• A patient is considered to have rheumatoid arthritis if at least four of the seven American Rheumatism Association criteria have been present for at least 6 weeks [19].
• The clinical picture of rheumatoid arthritis is characterized by synovitis and joint destruction, with synovitis tending to wax and wane [19].
• Joint destruction in rheumatoid arthritis starts within the first or second year of the disease and continues to progress [19].
• Radiographic signs of rheumatoid arthritis destruction include joint space narrowing, periarticular erosions, and subchondral osteopenia [19].
• Structural damage in rheumatoid arthritis manifests as pain with activity and deformity [19].
• Treatment of the early stages of rheumatoid arthritis is primarily medical, although physical and occupational therapy can be helpful [19].
• Pharmacologic agents used in rheumatoid arthritis include nonsteroidal antiinflammatory drugs, corticosteroids, methotrexate, and biologic agents [19].
• Biologic agents are recombinant proteins that generally target an inflammatory cytokine, such as tumor necrosis factor [19].
• Biologic agents have shown excellent results in rheumatoid arthritis treatment [19].
• Biologic agents inhibit the immune system and cause an increased risk of infection in patients taking them [19].
• Jämsen et al. found a 48% decrease in the number of primary arthroplasties performed for rheumatoid arthritis between 1995 and 2010, attributed to the effectiveness of improved medical management [19].
• There is preclinical evidence for an antioxidant, anti-inflammatory, antinociceptive, cartilage- and bone-protective effect of calcitonin in rheumatoid arthritis and osteoarthritis [16].
• Tectochrysin may be a novel rheumatoid arthritis therapeutic agent acting via macrophage JAK/STAT pathway inhibition, with promising clinical potential [14].
• Supervised high-intensity interval training and strength exercise appear to be feasible and well tolerated by patients and could be recommended to improve cardiovascular and physical health in patients with well-controlled rheumatoid arthritis [20].

Perioperative Medical Management

• Patients with rheumatoid arthritis on corticosteroids generally require preoperative “stress” dosages of hydrocortisone [19].
• Agents that inhibit the immune system should be withheld at least 1 week before and 1 week after a surgical procedure in patients with rheumatoid arthritis [19].
• Among patients with rheumatoid arthritis undergoing elective hand surgery, perioperative biologic disease-modifying antirheumatic drug continuation was not associated with significant increases in risks of wound healing failures or surgical site infections [15].

Operative

• The volume of total joint arthroplasty procedures conducted in patients with rheumatoid arthritis has trended markedly upward over the past decade, with a sharp increase after 2015 [1].
• Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty [6].
• Following total shoulder arthroplasty, patients with rheumatoid arthritis should be considered at higher risk of systemic and joint-related complications compared to patients with primary osteoarthritis [5].
• Shoulder arthroplasty in patients with rheumatoid arthritis reduces pain and improves function [10].
• In the largest single-institution study to date, patients with rheumatoid arthritis reported poorer patient-reported outcome scores compared with osteoarthritis and posttraumatic arthritis groups but experienced functional outcome improvement from the preoperative baseline following total ankle arthroplasty [7].
• Despite comparable complication rates between rheumatoid arthritis and non-rheumatoid arthritis cohorts, further investigation into the underlying mechanisms of increased revision rates in rheumatoid arthritis patients is warranted following total elbow arthroplasty [2].
• Patient-reported functional outcomes at 6 months were significantly lower in the fracture group compared to osteoarthritis and rheumatoid arthritis groups following total elbow arthroplasty [11].
• Comparative outcomes of robot-assisted versus conventional total knee arthroplasty provide important evidence for selecting surgical methods in rheumatoid osteoarthritis [4].

Key Considerations

Epidemiology and Trends

Perioperative Risk and Complications

• Patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery following primary total hip arthroplasty [6].
• Despite comparable complication rates between rheumatoid arthritis and non-RA cohorts in total elbow arthroplasty, further investigation into the underlying mechanisms of increased revision rates in RA patients is warranted [2].

Functional Outcomes and Patient-Reported Measures

• In the largest single-institution study to date, patients with rheumatoid arthritis reported poorer patient-reported outcome scores compared with osteoarthritis and posttraumatic arthritis groups following total ankle arthroplasty [7].

Long-Term Survivorship and Device Performance

• The Kudo type-5 prosthesis demonstrated satisfactory results in patients with rheumatoid arthritis, although failures occurred to some extent over a long-term follow-up period [18].
• Radiolunate arthrodesis in patients with rheumatoid arthritis maintained good clinical results and corrected alignment during long-term follow-up [22].

Surgical Technique Selection

Patient Education

• Physicians should provide information regarding the treatment of rheumatoid arthritis to patients in counseling and education materials [8].

Pharmacologic Management

Key Evidence

• [L4] The volume of total joint arthroplasty (TJA) procedures conducted in patients with rheumatoid arthritis has trended markedly upward over the past decade, with a sharp increase after 2015. [1] (10.5435/jaaosglobal-d-22-00209)
• [L3] Despite comparable complication rates between RA and non-RA cohorts, further investigation into the underlying mechanisms of increased revision rates in RA patients is warranted. [2] (10.1016/j.jse.2024.12.032)
• [L1] Denosumab demonstrates promising efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis. [3] (10.1186/s12891-025-08688-8)
• [L3] This provides important evidence for selecting surgical methods in rheumatoid osteoarthritis. [4] (10.1186/s13018-026-06703-9)
• [L3] Following TSA, RA patients should be considered at higher risk of systemic and joint-related complications compared to patients with primary OA. [5] (10.5397/cise.2024.00374)
• [L3] Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary THA. [6] (10.5435/jaaos-d-24-00656)
• [L3] In the largest single-institution study to date, patients with RA reported poorer PRO scores compared with the OA and posttraumatic arthritis groups but experienced functional outcome improvement from the preoperative baseline. [7] (10.2106/jbjs.24.00048)
• [L4] Physicians should provide such information to patients with RA in the counseling and education materials. [8] (10.1371/journal.pone.0285869)
• [L3] Inflammatory arthritis represents a distinctly morbid risk profile compared to osteoarthritis patients with multiple increased surgical and postoperative medical complications in patients undergoing aTSA and rTSA. [9] (10.1016/j.jse.2023.09.014)
• [L3] Shoulder arthroplasty in patients with rheumatoid arthritis reduces pain and improves function. [10] (10.1186/s13018-025-06109-z)
• [L3] Patient-reported functional outcomes at 6 months were significantly lower in the fracture group compared to osteoarthritis and rheumatoid arthritis groups. [11] (10.1016/j.jse.2026.01.019)
• [L3] Total knee arthroplasty in patients who have RA yields significant improvement in physician- and patient-reported outcomes. [12] (10.1016/j.arth.2026.03.021)
• [L3] In particular, both PsC and PsA were associated with higher rates of infections and all-cause revisions. [13] (10.1016/j.arth.2026.03.054)
• [L5] Tectochrysin may be a novel RA therapeutic agent, likely acting via macrophage JAK/STAT pathway inhibition, with promising clinical potential. [14] (10.1186/s13018-025-06481-w)
• [L2] Among patients with RA undergoing elective hand surgery, perioperative bDMARD continuation was not associated with significant increases in risks of wound healing failures or SSIs. [15] (10.1016/j.jhsa.2026.03.003)
• [L1] There is preclinical evidence for an antioxidant, anti-inflammatory, antinociceptive, cartilage- and bone-protective effect of CT in RA and OA. [16] (10.1530/eor-23-0133)
• [L4] Discontinuation of antiviral prophylaxis correlates with high prevalence of hepatitis B virus (HBV) reactivation in rheumatoid arthritis patients with HBV carrier state. [17] (10.1186/1471-2474-15-449)
• [L4] Although the Kudo type-5 prosthesis demonstrated satisfactory results in patients with RA, failures occurred to some extent over a long-term follow-up period. [18] (10.1016/j.jse.2024.10.025)
• [L1] Supervised HIIT and strength exercise appear to be feasible and well tolerated by patients and could be recommended to improve cardiovascular and physical health in patients with well-controlled RA. [20] (10.1136/bjsports-2024-108369)
• [L3] HandScan is able to reliably identify US-defined remission in RA at the joint level, with a good sensitivity and high PPV, while at the patient level, DAS-OST can also determine US remission but with lower performance. [21] (10.1186/s12891-024-07472-4)
• [L4] Radiolunate arthrodesis in patients with RA maintained good clinical results and corrected alignment, even during long-term follow-up. [22] (10.1016/j.jhsa.2022.11.014)

References

[1] Trends in Total Joint Arthroplasty Among Patients With Rheumatoid Arthritis: The Effect of Recent Disease Modifying Antirheumatic Drug Utilization Guidelines. JAAOS: Global Research and Reviews. 2022. DOI: 10.5435/jaaosglobal-d-22-00209

[2] Rates of long-term risk of revision and complications in total elbow arthroplasty in patients with rheumatoid arthritis: a propensity score-matched analysis. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.032

[3] Efficacy of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis: a meta-analysis of randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08688-8

[4] Comparative outcomes of robot-assisted versus conventional TKA in rheumatoid arthritis patients. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06703-9

[5] Rheumatoid arthritis is associated with higher 90-day systemic complications compared to osteoarthritis after total shoulder arthroplasty: a cohort study. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2024.00374

[6] Patient-Reported Outcome Measures After Direct Anterior Total Hip Arthroplasty Are Comparable Between Patients With Rheumatoid Arthritis and Osteoarthritis: A Propensity-Matched Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00656

[7] Complication Rates and Functional Outcomes After Total Ankle Arthroplasty in Patients with Rheumatoid Arthritis. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00048

[8] Internet search analysis on the treatment of rheumatoid arthritis: What do people ask and read online?. PLOS ONE. 2023. DOI: 10.1371/journal.pone.0285869

[9] Shoulder arthroplasty for inflammatory arthritis is associated with higher rates of medical and surgical complications: a nationwide matched cohort analysis from 2016-2020. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.09.014

[10] The moderating role of negative affect on pain in patients with rheumatoid arthritis who have undergone shoulder arthroplasty. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06109-z

[11] A comparison of survivorship and functional outcomes for total elbow arthroplasty performed for distal humerus fracture, rheumatoid arthritis, and osteoarthritis, a New Zealand Joint Registry study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.019

[12] Patient-Reported Outcomes and Satisfaction Following Total Knee Arthroplasty in Rheumatoid Arthritis: An Observational Cohort Study. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.03.021

[13] Outcomes Following Total Hip Arthroplasty in Patients with Cutaneous Psoriasis and Psoriatic Arthritis. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.03.054

[14] Targeting macrophage JAK3/STAT3 signaling with tectochrysin: a novel therapeutic strategy to ameliorate bone erosion and synovitis in rheumatoid arthritis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06481-w

[15] Perioperative Biologic Disease-Modifying Antirheumatic Drugs, Risks of Infections, and Wound Complications in Patients With Rheumatoid Arthritis Undergoing Elective Hand Surgery. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.03.003

[16] Calcitonin treatment for osteoarthritis and rheumatoid arthritis – a systematic review and meta-analysis of preclinical data. EFORT Open Reviews. 2024. DOI: 10.1530/eor-23-0133

[17] Discontinuation of antiviral prophylaxis correlates with high prevalence of hepatitis B virus (HBV) reactivation in rheumatoid arthritis patients with HBV carrier state: a real-world clinical practice. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-449

[18] Long-term follow-up study of Kudo type-5 elbow prosthesis in patients with rheumatoid arthritis: minimum 10-year clinical outcomes. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.10.025

[19] Campbell S Operative Orthopaedics 4 Volume Set. SOFT-TISSUE PROCEDURES AND OSTEOTOMIES ABOUT THE KNEE > RHEUMATOID ARTHRITIS OF THE KNEE > ADULT-ONSET RHEUMATOID ARTHRITIS.

[20] High-intensity interval training improves cardiovascular and physical health in patients with rheumatoid arthritis: a multicentre randomised controlled trial. British Journal of Sports Medicine. 2024. DOI: 10.1136/bjsports-2024-108369

[21] Optical imaging (HandScan) can identify ultrasound remission in rheumatoid arthritis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07472-4

[22] Radiolunate Arthrodesis in the Rheumatoid Wrist: A Retrospective Clinical and Radiologic Long-Term Follow-Up. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.11.014