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炎症性与类风湿性关节炎 资料

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会注意到关节感到僵硬和疼痛，尤其是在刚醒来时。这种晨间僵硬通常会使简单的任务变得困难。您可能难以将手伸到背后扣上胸罩或塞好衬衫。在高处架子上取物品也可能变得具有挑战性。这些日常动作可能会导致全天持续的不适。

您的疼痛可能在活动后加剧。休息可能有助于缓解酸痛，但长时间不活动有时会使僵硬加重。如果您的肩膀或髋关节受到影响，您可能会发现很难侧卧睡觉。疼痛会干扰您的休息，使您感到疲惫和沮丧。这是炎症性关节炎患者常见的经历。

重要的是要知道，您的身体对手术的反应与患有磨损性关节炎的人不同。如果您接受关节置换手术，例如肘部、膝盖或肩膀，您面临更高的并发症风险。这包括医疗问题和手术问题。与没有炎症性疾病的患者相比，您后来更需要翻修手术的可能性也更大。

尽管存在这些风险，许多患者仍然看到了显著的益处。在全髋关节置换术后，您可以预期疼痛减轻和功能改善，效果与其他人相似。您的外科医生可能会讨论诸如机器人辅助技术用于膝盖等选项，以帮助选择最佳的手术方法。对于您的脚踝，即使结果不如其他类型的关节炎那样显著，您也可能从基线水平体验到功能改善。

如果您还患有骨质疏松症，您的骨骼健康是首要任务。您的护理团队可能会推荐如地舒单抗等治疗，以维持骨骼强度并防止进一步的关节损伤。了解这些风险和益处有助于您为前方的旅程做好准备。您的外科医生将根据您的具体需求和健康状况量身定制计划。

实际发生了什么

类风湿关节炎是一种自身免疫性疾病。您的免疫系统错误地攻击关节的衬里。这种衬里被称为滑膜。可以将其想象为缓冲和润滑关节的“袖套”。当这个袖套发生炎症时，它会肿胀并增厚。这一过程会损伤骨端的光滑覆盖层，即软骨。软骨起到减震器的作用。如果没有软骨，您的骨头会相互摩擦。这会导致疼痛、僵硬和肿胀。

这种炎症不会局限于某一处。它通常同时影响多个关节。持续的刺激会削弱关节周围的结构。肌腱（像由纤维组成的强韧绳索）可能会拉伸或撕裂。韧带（负责将骨头连接在一起）可能会松弛。这会导致关节不稳定和畸形，且随时间推移而加重。由于该疾病是系统性的，它会影响您的全身。这就是为什么即使关节没有明显疼痛，您仍可能感到疲劳或不适。

这种炎症造成的损害会改变关节的功能。在某些情况下，如骨质疏松症，骨头本身会变得更弱、更脆弱。这使得它们更容易发生骨折。当需要手术时，例如关节置换术，您的外科医生必须考虑到这种脆弱的组织。炎症环境可能会增加术后并发症的风险。例如，与退行性关节炎患者相比，类风湿关节炎患者可能面临更高的医疗问题或感染风险。

尽管存在这些挑战，手术仍然非常有效。许多患者经历了显著的疼痛缓解和功能改善。您的外科医生会根据您特定的关节损伤情况定制手术方案。他们会考虑您骨骼和软组织健康状况。目标是恢复活动能力并减轻疼痛。虽然风险高于简单的退行性关节炎，但结果可能非常理想。在髋关节或膝关节置换等手术后，您可以预期疼痛减轻和日常功能改善。关键在于控制潜在的炎症，以保护您的新关节和整体健康。

预期情况

您的预后在很大程度上取决于受累的关节类型以及您所患的关节炎类型。类风湿关节炎是一种全身性疾病，其康复过程可能比退行性（磨损性）关节炎更为复杂。在许多情况下，关节置换手术可带来显著的缓解。在接受髋关节或膝关节置换等手术后，您预计会出现疼痛减轻和功能改善。这些结果通常与非炎症性关节炎患者的结果相似。

然而，您的身体反应可能与单纯骨关节炎患者不同。例如，患有炎症性关节炎的患者接受肩部手术时，发生医疗和手术并发症的风险均较高。与仅存在原发性磨损问题的患者相比，您接受翻修手术的风险也更高。同样，与其他类型的关节炎相比，踝关节置换术可能导致患者报告结局评分较低，但您仍会从基线水平获得功能改善。

如果您同时患有骨质疏松症和类风湿关节炎，维持骨骼健康至关重要。地舒单抗等治疗有助于防止进一步的关节损伤并支持骨骼健康。若管理不当，并发症风险将增加。与骨关节炎相比，炎症性关节炎术后出现医疗相关问题的风险显著更高。

诚实地面对这些风险非常重要。虽然许多患者取得了良好的疗效，但您应预期康复过程会更加谨慎。您的外科医生将根据这些特定风险量身定制您的治疗方案。目标是有效控制疾病，使您能够恢复活动能力并减轻疼痛，即使康复之路比其他人稍具挑战性。

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

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

  • Total elbow arthroplasty in patients with rheumatoid arthritis is associated with increased revision rates compared to non-RA cohorts, despite comparable complication rates [1].
  • Denosumab demonstrates efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis [2].
  • Robot-assisted total knee arthroplasty provides evidence for selecting surgical methods in rheumatoid osteoarthritis compared to conventional techniques [3].
  • Rheumatoid arthritis is associated with higher 90-day systemic complications compared to osteoarthritis after total shoulder arthroplasty [4].
  • Patients with rheumatoid arthritis are at higher risk of systemic and joint-related complications following total shoulder arthroplasty compared to patients with primary osteoarthritis [4].
  • Patient-reported outcome measures after direct anterior total hip arthroplasty are comparable between patients with rheumatoid arthritis and osteoarthritis [5].
  • Patients with rheumatoid arthritis can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty [5].
  • Patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery following total hip arthroplasty [5].
  • Patients with rheumatoid arthritis reported poorer patient-reported outcome scores compared with osteoarthritis and posttraumatic arthritis groups after total ankle arthroplasty [6].
  • Patients with rheumatoid arthritis experienced functional outcome improvement from the preoperative baseline after total ankle arthroplasty [6].
  • Shoulder arthroplasty for inflammatory arthritis is associated with higher rates of medical and surgical complications compared to osteoarthritis [7].
  • Inflammatory arthritis represents a distinctly morbid risk profile with multiple increased surgical and postoperative medical complications in patients undergoing anatomic and reverse total shoulder arthroplasty [7].
  • Total knee arthroplasty in patients with rheumatoid arthritis yields significant improvement in physician- and patient-reported outcomes [8].
  • Cutaneous psoriasis and psoriatic arthritis are associated with higher rates of infections and all-cause revisions following total hip arthroplasty [13].

Background & Causes

  • Rheumatoid arthritis is associated with higher 90-day systemic complications compared to osteoarthritis after total shoulder arthroplasty [4].
  • 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 [7].
  • Patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery following primary total hip arthroplasty [5].
  • Rates of long-term risk of revision in total elbow arthroplasty are increased in patients with rheumatoid arthritis compared to non-RA cohorts [1].
  • Denosumab demonstrates efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis [2].
  • Denosumab reduced joint mTSS, JSN, and BES, alleviated joint space narrowing, and inhibited bone erosion in rheumatoid arthritis patients [21].
  • Perioperative bDMARD continuation was not associated with significant increases in risks of wound healing failures or SSIs among patients with RA undergoing elective hand surgery [10].
  • Shoulder arthroplasty in patients with rheumatoid arthritis reduces pain and improves function [11].
  • Patients with RA reported poorer PRO scores compared with OA and posttraumatic arthritis groups after total ankle arthroplasty but experienced functional outcome improvement from the preoperative baseline [6].
  • The Kudo type-5 prosthesis demonstrated satisfactory results in patients with RA but failures occurred to some extent over a long-term follow-up period [14].
  • Tectochrysin may be a novel RA therapeutic agent, likely acting via macrophage JAK/STAT pathway inhibition, with promising clinical potential [15].
  • There is preclinical evidence for an antioxidant, anti-inflammatory, antinociceptive, cartilage- and bone-protective effect of calcitonin in RA [16].

Symptoms & Presentation

  • Internet search analysis reveals specific questions and reading behaviors regarding the treatment of rheumatoid arthritis among patients [9].
  • 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].
  • DAS-OST can determine ultrasound-defined remission at the patient level in rheumatoid arthritis, but with lower performance compared to joint-level identification [18].
  • Chronic non-specific tenosynovitis with effusion localized at the ankle may present with intermittent symptoms that remain unrecognized for months or even years [17].

Management

  • Total elbow arthroplasty in patients with rheumatoid arthritis is associated with higher long-term revision rates compared to non-RA cohorts, despite comparable complication rates [1].
  • Robot-assisted total knee arthroplasty provides evidence for surgical method selection in rheumatoid osteoarthritis [3].
  • Patients with rheumatoid arthritis undergoing total shoulder arthroplasty are at higher risk of systemic and joint-related complications compared to patients with primary osteoarthritis [4].
  • Patient-reported outcome measures after direct anterior total hip arthroplasty are comparable between patients with rheumatoid arthritis and osteoarthritis [5].
  • Patients with rheumatoid arthritis can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty [5].
  • Patients with rheumatoid arthritis undergoing total ankle arthroplasty reported poorer patient-reported outcome scores compared with osteoarthritis and posttraumatic arthritis groups [6].
  • Patients with rheumatoid arthritis undergoing total ankle arthroplasty experienced functional outcome improvement from the preoperative baseline [6].
  • Shoulder arthroplasty for inflammatory arthritis is associated with higher rates of medical and surgical complications compared to osteoarthritis [7].
  • Inflammatory arthritis represents a distinctly morbid risk profile with multiple increased surgical and postoperative medical complications in patients undergoing anatomic and reverse total shoulder arthroplasty [7].
  • Total knee arthroplasty in patients with rheumatoid arthritis yields significant improvement in physician-reported outcomes [8].
  • Total knee arthroplasty in patients with rheumatoid arthritis yields significant improvement in patient-reported outcomes [8].
  • Physicians should provide internet search-derived information on rheumatoid arthritis treatment to patients in counseling and education materials [9].
  • Perioperative biologic disease-modifying antirheumatic drug continuation in patients with rheumatoid arthritis undergoing elective hand surgery was not associated with significant increases in risks of wound healing failures or surgical site infections [10].
  • Negative affect moderates pain in patients with rheumatoid arthritis who have undergone shoulder arthroplasty [11].
  • Patient-reported functional outcomes at 6 months after total elbow arthroplasty were significantly lower in the fracture group compared to osteoarthritis and rheumatoid arthritis groups [12].
  • Targeting macrophage JAK3/STAT3 signaling with tectochrysin ameliorates bone erosion and synovitis in rheumatoid arthritis [15].
  • Tectochrysin acts via macrophage JAK/STAT pathway inhibition and has promising clinical potential as a novel rheumatoid arthritis therapeutic agent [15].
  • Preclinical evidence supports an antioxidant, anti-inflammatory, antinociceptive, cartilage-protective, and bone-protective effect of calcitonin in rheumatoid arthritis [16].

Key Considerations

  • Total elbow arthroplasty in patients with rheumatoid arthritis has comparable complication rates to non-RA cohorts [1].
  • Total elbow arthroplasty in patients with rheumatoid arthritis is associated with increased revision rates compared to non-RA cohorts [1].
  • Robot-assisted total knee arthroplasty provides evidence for selecting surgical methods in rheumatoid osteoarthritis [3].
  • Patients with rheumatoid arthritis are at higher risk of systemic and joint-related complications following total shoulder arthroplasty compared to patients with primary osteoarthritis [4].
  • Patients with rheumatoid arthritis may be at increased risk of complications and revision surgery following total hip arthroplasty [5].
  • Patients with rheumatoid arthritis reported poorer patient-reported outcome scores compared with osteoarthritis and posttraumatic arthritis groups after total ankle arthroplasty [6].
  • Patients with rheumatoid arthritis experienced functional outcome improvement from the preoperative baseline after total ankle arthroplasty [6].
  • Physicians should provide information on internet search trends regarding rheumatoid arthritis treatment to patients in counseling and education materials [9].
  • Perioperative biologic disease-modifying antirheumatic drug continuation was not associated with significant increases in risks of wound healing failures or surgical site infections among patients with rheumatoid arthritis undergoing elective hand surgery [10].
  • The Kudo type-5 prosthesis demonstrated satisfactory results in patients with rheumatoid arthritis over a minimum 10-year follow-up period [14].
  • Failures of the Kudo type-5 prosthesis occurred to some extent over a long-term follow-up period in patients with rheumatoid arthritis [14].
  • Radiolunate arthrodesis in patients with rheumatoid arthritis maintained good clinical results and corrected alignment during long-term follow-up [19].
  • 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 [22].

Key Evidence

  • [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. [1] (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. [2] (10.1186/s12891-025-08688-8)
  • [L3] This provides important evidence for selecting surgical methods in rheumatoid osteoarthritis. [3] (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. [4] (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. [5] (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. [6] (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. [7] (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. [8] (10.1016/j.arth.2026.03.021)
  • [L4] Physicians should provide such information to patients with RA in the counseling and education materials. [9] (10.1371/journal.pone.0285869)
  • [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. [10] (10.1016/j.jhsa.2026.03.003)
  • [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)
  • [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)
  • [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. [14] (10.1016/j.jse.2024.10.025)
  • [L5] Tectochrysin may be a novel RA therapeutic agent, likely acting via macrophage JAK/STAT pathway inhibition, with promising clinical potential. [15] (10.1186/s13018-025-06481-w)
  • [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] In chronic non-specific tenosynovitis with effusion localized at the ankle, symptoms may be intermittent and the true nature of the condition may remain unrecognized for months or even years. [17] (10.2106/jbjs.25.00400)
  • [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)
  • [L4] Radiolunate arthrodesis in patients with RA maintained good clinical results and corrected alignment, even during long-term follow-up. [19] (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. [21] (10.1186/s12891-025-09206-6)
  • [L4] Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery. [22] (10.1016/j.jhsa.2024.03.002)

References

[1] 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

[2] 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

[3] 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

[4] 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

[5] 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

[6] 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

[7] 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

[8] 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

[9] 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

[10] 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

[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] 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] 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

[15] 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

[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] Complication Rates and Functional Outcomes After TAA in Patients with Rheumatoid Arthritis Are Less Defined Than for Patients with Osteoarthritis. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.25.00400

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

[19] 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

[21] 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

[22] 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

专业协会这些代表什么？→