If the pain medication isn't working well, if doing simple things like climbing the stairs approach the near-impossible point, then surgery for your rheumatoid arthritis could be an option.

People with rheumatoid arthritis, a crippling autoimmune disorder that affects the joints, can have surgery to relieve pain and improve function. There are numerous surgical options, but the type of surgery is determined by the patient’s disease stage.

“Surgery plays an important role for patients with RA,” says John H. Klippel, MD, president and CEO of the Arthritis Foundation in Atlanta. Surgery generally happens for two reasons:

• It improves the function of damaged joints.
• It relieves pain.

Surgery becomes an option, depending on:

• How well your medications relieve pain
• How well they prevent damage to your joints
• How severe your rheumatoid arthritis is

Rheumatoid Arthritis: Questions to Consider

Questions you may ask yourself when considering surgery for rheumatoid arthritis include:

• Do my rheumatoid arthritis medications fail to relieve pain?
• Can I do simple things, like walk up the stairs or get up from the toilet?
• Does pain keep me from getting a good night’s sleep?
• Does my disease prevent me from running errands, eating out, or enjoying a social life?

Your doctor will also consider other factors prior to proceeding with surgery for RA. These factors include:

• Overall health status. Diabetes, skin infections, high blood pressure, lung problems, or heart disease may make you a poor candidate for surgery.
• Obesity. Patients who are overweight may have a more difficult time with recovery from surgery. Also, artificial joints may not last as long in heavier patients.
• Age. Doctors may discourage patients under age 30 from having joint replacement surgery because artificial joints tend to wear out more quickly in younger, more active patients. That said, doctors may be reluctant to perform surgery on the elderly due to the risk that the surgery itself presents.
• Bone density. Osteoporosis should be treated both prior to and after surgery for rheumatoid arthritis to help make bones strong enough to support a replaced joint.

Rheumatoid Arthritis: Surgical Options

Dr. Klippel says three surgical procedures are most often recommended for patients with rheumatoid arthritis.

“The most common is total joint replacement of the knees and hips, although nearly all major joints can be replaced,” says Klippel. In this procedure, the joint is either replaced or reconstructed with a man-made component or prosthesis.

Surgery on hips and knees are the most successful types of surgery for rheumatoid arthritis patients.

The second most common surgical treatment involves the feet. Rheumatoid arthritis damages ball joints, making it difficult for patients to walk, explains Klippel. One of the surgical options is fusion of the foot and ankle joint, in which the joint is surgically modified to join as a single bone. While this will decrease mobility, your foot and ankle will still be functional and generally without pain.

The third procedure involves hands and wrists. “Surgery may be performed to correct deformities in the hand and wrist to improve hand function,” says Klippel.

Other surgical treatment options include:

• Synovectomy. Removal of the synovium or lining of the joint may help to reduce swelling and prevent further damage to the joint. This procedure is usually performed at the disease’s early stages.
• Osteotomy. In this procedure, a piece of bone may be removed or bones around the joint may be cut to correct a deformity.
• Arthrodesis or fusion. This surgical treatment involves fusing the bones of the joint together to immobilize the joint. Arthrodesis is used primary in joints of the ankles, fingers, spine, toes, and wrist, and is usually performed in the later stages of RA.
• Arthroscopic surgery. For this surgery, which is most often performed on knees and shoulders, the surgeon makes a small incision in the damaged joint and inserts a narrow tube with a light and camera. The camera, which is connected to a monitor, lets the surgeon see the damaged joint and surrounding tissue. During arthroscopic surgery, the doctor may remove loose cartilage or diseased synovial tissue as well as repair tears in tendons and ligaments.
• Surgery to ease compressed or pinched nerves. Also called nerve entrapment, this condition results when there is physical compression of nerves. Rheumatoid arthritis patients may experience nerve entrapment in the elbows (ulnar neuritis), wrists (carpal tunnel syndrome), or heels and toes (tarsal tunnel syndrome). With ulnar neuritis, surgery may be performed to move the ulnar nerve from the groove of the elbow to the front part of the elbow. Surgery to decompress the carpal (wrist) or tarsal (foot) tunnel is an option if pain and weakness persists with the use of splints and medications.

If rheumatoid arthritis is limiting your activities and you are not getting proper pain relief, surgery may be right for you. Your doctor can determine which surgical treatment option is suitable for your rheumatoid arthritis and your lifestyle and, most importantly, which surgery will bring you welcome relief.