Artrite inflamatória e reumatoide Folheto

O que você está sentindo

A artrite inflamatória, incluindo a artrite reumatoide, é diferente da artrite por desgaste. O seu sistema imunológico ataca o revestimento das articulações, causando inchaço e dor. Ela costuma afetar várias articulações ao mesmo tempo, e a mesma articulação dos dois lados do corpo.

A dor costuma seguir um padrão. Muitas pessoas acordam rígidas e doloridas, e pode levar algum tempo até as articulações se soltarem. Durante uma crise, as articulações podem parecer inchadas e ficar quentes. O repouso alivia a dor, mas a atividade pode despertá-la novamente, e as crises podem atrapalhar o seu sono.

Como o revestimento articular permanece inflamado, a cartilagem (a superfície lisa que permite que as articulações deslizem) se desgasta. Tarefas cotidianas que exigem esforço da articulação tornam-se mais difíceis. Dependendo de quais articulações são afetadas, você pode ter dificuldade para segurar uma chaleira, girar uma maçaneta, caminhar até a caixa de correio ou levantar-se de uma cadeira baixa.

Como a doença afeta todo o corpo, e não apenas uma articulação, ela também pode causar cansaço. Você pode se sentir esgotado mesmo nos dias em que as articulações estão mais calmas.

Se as suas articulações estão ficando mais doloridas ou rígidas apesar do tratamento do seu reumatologista, pode ser hora de conversar sobre cirurgia.

O que realmente está acontecendo

Na artrite por desgaste, a articulação simplesmente se desgasta com o tempo. A artrite inflamatória é diferente. O seu sistema imunológico, que normalmente combate infecções, confunde o revestimento das articulações com algo prejudicial e o ataca.

Pense nesse revestimento como um pano macio e úmido que mantém a articulação lubrificada e nutrida. Quando está sob ataque constante, ele incha e produz líquido em excesso. A articulação fica inchada, quente e rígida, que é a crise que você já conhece da seção acima.

Esse inchaço não fica apenas parado ali. Ele libera substâncias que corroem a cartilagem, a superfície lisa que permite que a articulação deslize. Depois que a cartilagem desaparece, osso atrita contra osso. A inflamação também pode enfraquecer os ligamentos e tendões que mantêm a articulação estável, de modo que a articulação pode ficar frouxa ou sair do alinhamento. A dor, a rigidez e a dificuldade com as tarefas do dia a dia que você sente são o resultado desse dano contínuo.

Como a doença vem do sistema imunológico, e não apenas do desgaste, ela costuma afetar várias articulações ao mesmo tempo e pode afetar a mesma articulação dos dois lados do corpo. Isso também explica por que os medicamentos do seu reumatologista são tão importantes: eles acalmam o ataque imunológico e protegem as suas articulações. Mas, quando uma articulação já foi muito danificada, os medicamentos sozinhos não conseguem reconstruir a superfície, e é aí que a cirurgia entra em cena.

Substituir uma articulação danificada por uma artificial remove as superfícies desgastadas que continuam provocando crises. Pessoas com artrite reumatoide que substituem o quadril ou o joelho geralmente obtêm um alívio real da dor e se movimentam melhor depois, de forma muito semelhante às pessoas com artrite por desgaste. A cirurgia numa articulação inflamada pode trazer alguns riscos a mais do que a cirurgia para artrite por desgaste, e o seu cirurgião vai discuti-los com você antes de qualquer decisão.

O que esperar

A artrite inflamatória costuma ir e vir. Você pode ter períodos mais calmos entre as crises, mas a inflamação de base tende a continuar agindo em segundo plano. Com o tempo, sem tratamento, o revestimento articular permanece inflamado e o dano à cartilagem, aos ligamentos e aos tendões se acumula. É por isso que os medicamentos do seu reumatologista são tão importantes: iniciados cedo e bem controlados, eles acalmam as crises e retardam o dano.

Quando uma articulação já está muito danificada, substituí-la pode mudar o prognóstico. Pessoas com artrite reumatoide que substituem o quadril ou o joelho geralmente obtêm um alívio real da dor e se movimentam melhor depois, de forma muito semelhante às pessoas com artrite por desgaste. O mesmo vale para a prótese de ombro: ela reduz a dor e melhora a função. A prótese de tornozelo também melhora o funcionamento da articulação em comparação com antes da cirurgia, embora as pessoas com artrite reumatoide tendam a relatar menos melhora do que as pessoas com outros tipos de artrite.

É honesto dizer que a cirurgia numa articulação inflamada traz alguns riscos a mais do que a cirurgia para artrite por desgaste. Como a doença afeta todo o corpo, e não apenas a articulação, há uma chance maior de problemas clínicos e de problemas com a própria articulação nova, e uma chance um pouco maior de precisar de outra operação no futuro. O seu cirurgião vai discutir esses riscos com você antes de qualquer decisão, e eles são um dos motivos pelos quais o acompanhamento do seu reumatologista continua junto com a cirurgia, em vez de terminar nela.

A recuperação após a substituição articular é gradual. A maioria das pessoas percebe que a dor profunda e áspera da articulação desgastada desaparece logo após a cirurgia, e que a nova articulação parece mais firme. Recuperar a força e a confiança leva de semanas a meses, com a orientação do seu fisioterapeuta. Tenha expectativas realistas: o objetivo é menos dor e melhor função para tarefas do dia a dia, como segurar objetos, caminhar e levantar-se de uma cadeira, e não uma articulação que pareça nova em folha. Muitas pessoas chegam muito perto disso, mas a doença em si continua com você, por isso a sua equipe médica segue trabalhando com você no quadro geral.

Evidence & references

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].
Total knee arthroplasty in patients with rheumatoid arthritis yields significant improvement in physician- and patient-reported outcomes [10].
Patient-reported outcome measures after direct anterior total hip arthroplasty are comparable between patients with rheumatoid arthritis and osteoarthritis [6].
Patients with rheumatoid arthritis can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty [6].
Patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery following total hip arthroplasty [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 [8].
Patients with rheumatoid arthritis experienced functional outcome improvement from the preoperative baseline following total ankle arthroplasty [8].
Shoulder arthroplasty in patients with rheumatoid arthritis reduces pain and improves function [11].
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 [12].
Despite comparable complication rates between rheumatoid arthritis and non-RA cohorts, further investigation into the underlying mechanisms of increased revision rates in RA patients is warranted [2].
Denosumab demonstrates promising efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis [3].
There is preclinical evidence for an antioxidant, anti-inflammatory, antinociceptive, cartilage- and bone-protective effect of calcitonin in rheumatoid arthritis and osteoarthritis [13].
Discontinuation of antiviral prophylaxis correlates with high prevalence of hepatitis B virus reactivation in rheumatoid arthritis patients with hepatitis B virus carrier state [14].
Cutaneous psoriasis and psoriatic arthritis were associated with higher rates of infections and all-cause revisions following total hip arthroplasty [15].
Careful monitoring should be conducted for total elbow arthroplasty in rheumatoid arthritis cases with a short duration from RA onset to surgery, preoperative instability, misalignment of the implant, and the use of the all-polyethylene ulnar component [16].

Background & Causes

Discontinuation of antiviral prophylaxis correlates with a high prevalence of hepatitis B virus reactivation in rheumatoid arthritis patients with an HBV carrier state [14].
Nonsurgical management of distal radius fractures in patients with inflammatory arthropathies carries a risk of attritional dorsal carpal dislocation and multiple flexor tendon ruptures [25].
Preoperative severe ulnar translation deformity is a risk factor for postoperative degeneration of the midcarpal joint following radiolunate arthrodesis in the rheumatoid wrist [22].
Pre-existing degenerative changes at the midcarpal joint may lead to loss of wrist range of motion following radiolunate arthrodesis in the rheumatoid wrist [22].

Symptoms & Presentation

Patients with rheumatoid arthritis (RA) report poorer patient-reported outcome (PRO) scores compared with osteoarthritis and posttraumatic arthritis groups following total ankle arthroplasty [8].
Patients with RA undergoing shoulder arthroplasty experience reduced pain and improved function [11].
Patients with RA undergoing total knee arthroplasty yield significant improvement in physician- and patient-reported outcomes [10].
Patients with RA can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty [6].
Unlinked total elbow arthroplasty via the lateral para-olecranon approach in patients with RA achieves significant improvements in pain, range of motion, strength, and overall elbow function [24].
Total wrist arthroplasty using the semiconstrained arthroplasty system in patients with RA achieves favorable clinical outcomes [26].
Patient-reported functional outcomes at 6 months for total elbow arthroplasty were significantly lower in the fracture group compared to osteoarthritis and rheumatoid arthritis groups [12].
Pre-existing degenerative changes at the midcarpal joint might lead to loss of wrist range of motion following radiolunate arthrodesis in the rheumatoid wrist [22].
Nonsurgical management of distal radius fractures in patients with inflammatory arthropathies carries the potential for attritional dorsal carpal dislocation and multiple flexor tendon ruptures [25].

Management

Non-Operative and Systemic Considerations

Denosumab reduced joint mTSS, JSN, and BES, alleviated joint space narrowing, and inhibited bone erosion, providing maximal joint protection and maintaining joint function [23].
Tectochrysin may be a novel rheumatoid arthritis therapeutic agent, likely acting via macrophage JAK/STAT pathway inhibition, with promising clinical potential [20].
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 [19].
Discontinuation of antiviral prophylaxis correlates with a high prevalence of hepatitis B virus reactivation in rheumatoid arthritis patients with hepatitis B virus carrier state [14].
HandScan is able to reliably identify ultrasound-defined remission in rheumatoid arthritis at the joint level, with good sensitivity and high positive predictive value [18].
At the patient level, DAS-OST can determine ultrasound remission in rheumatoid arthritis but with lower performance than HandScan [18].
Physicians should provide information regarding online treatment queries to patients with rheumatoid arthritis in counseling and education materials [7].

Perioperative Medical Management

Among patients with rheumatoid arthritis undergoing elective hand surgery, perioperative continuation of biologic disease-modifying antirheumatic drugs was not associated with significant increases in risks of wound healing failures or surgical site infections [17].
Patients with rheumatoid arthritis who are on corticosteroids generally require preoperative "stress" dosages of hydrocortisone [27].
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 [27].
Biologic agents used in rheumatoid arthritis inhibit the immune system and cause an increased risk of infection in patients taking them [27].

Arthroplasty Outcomes and Complications

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].
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].
Inflammatory arthritis represents a distinctly morbid risk profile compared to osteoarthritis patients, with multiple increased surgical and postoperative medical complications in patients undergoing anatomic or reverse total shoulder arthroplasty [9].
Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, they can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty [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 but experienced functional outcome improvement from the preoperative baseline [8].
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].
Both cutaneous psoriasis and psoriatic arthritis were associated with higher rates of infections and all-cause revisions following total hip arthroplasty [15].

Surgical Techniques and Monitoring

Unlinked total elbow arthroplasty performed via the lateral para-olecranon approach provides favorable midterm outcomes in patients with rheumatoid arthritis and Larsen grade III–IV disease, preserving triceps function while achieving significant improvements in pain, range of motion, strength, and overall elbow function [24].
Careful monitoring should be conducted for total elbow arthroplasty in rheumatoid arthritis cases with a short duration from disease onset to surgery, preoperative instability, misalignment of the implant, and the use of the all-polyethylene ulnar component [16].
Comparative outcomes of robot-assisted versus conventional total knee arthroplasty in rheumatoid arthritis patients provide important evidence for selecting surgical methods in rheumatoid osteoarthritis [4].

Key Considerations

Epidemiology and Trends

Perioperative Risk and Complications

Patients with rheumatoid arthritis undergoing elective hand surgery who continue perioperative biologic disease-modifying antirheumatic drugs do not have a significant increase in risks of wound healing failures or surgical site infections [17].
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 [14].

Joint-Specific Outcomes

Patients with rheumatoid arthritis can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty, despite an increased risk of complications and revision surgery [6].
Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery in patients with rheumatoid arthritis [26].
Anatomic shoulder replacement has superior functional outcomes compared with reverse shoulder replacement in patients with inflammatory arthritis, with no significant difference in revision-free survival rates between the two procedures [28].

Revision and Survivorship

Further investigation into the underlying mechanisms of increased revision rates in rheumatoid arthritis patients undergoing total elbow arthroplasty is warranted, despite comparable complication rates between rheumatoid arthritis and non-rheumatoid arthritis cohorts [2].

Non-Operative and Adjunctive Considerations

HandScan optical imaging can reliably identify ultrasound-defined remission in rheumatoid arthritis at the joint level with good sensitivity and high positive predictive value [18].

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)
[L4] Physicians should provide such information to patients with RA in the counseling and education materials. [7] (10.1371/journal.pone.0285869)
[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. [8] (10.2106/jbjs.24.00048)
[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] Total knee arthroplasty in patients who have RA yields significant improvement in physician- and patient-reported outcomes. [10] (10.1016/j.arth.2026.03.021)
[L3] Shoulder arthroplasty in patients with rheumatoid arthritis reduces pain and improves function. [11] (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. [12] (10.1016/j.jse.2026.01.019)
[L1] There is preclinical evidence for an antioxidant, anti-inflammatory, antinociceptive, cartilage- and bone-protective effect of CT in RA and OA. [13] (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. [14] (10.1186/1471-2474-15-449)
[L3] In particular, both PsC and PsA were associated with higher rates of infections and all-cause revisions. [15] (10.1016/j.arth.2026.03.054)
[L4] Careful monitoring should be conducted, particularly in cases with a short duration from RA onset to surgery, preoperative instability, misalignment of the implant, and the use of the all-polyethylene ulnar component. [16] (10.1016/j.jse.2024.10.025)
[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. [17] (10.1016/j.jhsa.2026.03.003)
[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. [18] (10.1186/s12891-024-07472-4)
[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. [19] (10.1136/bjsports-2024-108369)
[L5] Tectochrysin may be a novel RA therapeutic agent, likely acting via macrophage JAK/STAT pathway inhibition, with promising clinical potential. [20] (10.1186/s13018-025-06481-w)
[L4] Preoperative severe ulnar translation deformity was a risk factor for postoperative degeneration of the midcarpal joint, and pre-existing degenerative changes at the midcarpal joint might lead to loss of wrist range of motion. [22] (10.1016/j.jhsa.2022.11.014)
[L1] Additionally, it reduced joint mTSS, JSN, and BES, alleviated joint space narrowing, and inhibited bone erosion, providing maximal joint protection and maintaining joint function. [23] (10.1186/s12891-025-09206-6)
[L4] Unlinked TEA performed via the lateral para-olecranon approach provides favorable midterm outcomes in patients with RA and Larsen grade III–IV disease, preserving triceps function while achieving significant improvements in pain, ROM, strength, and overall elbow function. [24] (10.1016/j.jse.2026.02.023)
[L4] This case highlights the risks associated with nonsurgical management of distal radius fractures in patients with inflammatory arthropathies, specifically the potential for attritional dorsal carpal dislocation and multiple flexor tendon ruptures. [25] (10.1016/j.jhsg.2025.100933)
[L4] Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery. [26] (10.1016/j.jhsa.2024.03.002)
[L3] There was no significant difference in revision-free survival rates between the two procedures. [28] (10.1016/j.jse.2026.02.009)

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] 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

[8] 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

[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] 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

[11] 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

[12] 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

[13] 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

[14] 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

[15] 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

[16] 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

[17] 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

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

[19] 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

[20] 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

[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

[23] Efficacy and safety of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis: a meta-analysis and systematic review. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09206-6

[24] The Lateral Para-olecranon Approach for Unlinked Total Elbow Arthroplasty with the Kudo Prosthesis in Patients with Rheumatoid Arthritis: Midterm Outcomes. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.023

[25] Attritional Carpal Dislocation and Flexor Tendon Rupture as a Rare Complication of Conservatively Managed Distal Radius Fracture in a Rheumatoid Patient. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2025.100933

[26] Clinical Outcomes of Total Wrist Arthroplasty in Patients With Rheumatoid Arthritis: Minimum 10-Year Follow-Up Study. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.03.002

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

[28] Anatomic shoulder replacement has superior functional outcomes with equivalent survivorship compared with reverse shoulder replacement in patients with inflammatory arthritis—New Zealand registry results. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.009