Surgery May be Part of Your Battle With RA

A sixth RA-related surgery is scheduled for a few weeks. The goal is to remove damaged bone and tendon in the elbow and to reattach tendons to the joint using anchors. Rheumatoid arthritis impacts both of my elbows but at this point only the right one needs surgery. Since dealing with this disease I’ve had three ankle surgeries to remove eroded bone and damaged soft tissue; two on the right and one of the left ankle. During the last foray into the ankle, a tissue sample was collected and sent to the laboratory for analysis and it confirmed that the damage was indeed caused by inflammatory processes from rheumatoid arthritis. A few years back recurrent sinus infections worsened by immune suppressing RA drugs resulted in surgery. And just last spring, three cervical vertebrae were fused. Yet, some bone spurs remain in the neck and may need to be removed in the future if they aggravate nerves. All of these surgeries occurred in the short span of seven years – an average of one per year. Before this time, such invasive procedures were not part of my life.

Unfortunately, the ravaging effects of rheumatoid arthritis on bone and accompanying soft tissues may result in the need for surgery. In spite of more effective treatments developed and used over the past couple of decades, tissue damage can still occur. When joint damage occurs, conservative treatments are generally attempted first and may include rest, immobilization, physical therapy, or steroid injections. At the point that conservative treatments don’t work or the damage is too extensive, surgery may be a valid treatment option. Surgery can help relieve pain and restore function to joints (University of Washington).¹

Several types of surgery may be utilized for RA (Hospital for Special Surgery).² Damaged bony and soft tissues may need to be repaired (University of Washington).³ Such was the case with my ankles and elbow. Surgery on damaged hands and wrists is not uncommon in RA patients. A synovectomy is another type of tissue repair in which the capsule surrounding a joint where much RA damage occurs, the synovium, is surgically removed in an effort to reduce the damaging RA processes. Joint inflammation and damage from RA can also impact surrounding nerve tissue. Sometimes surgery is needed to release entrapped and damaged nerves as in the case of my recent neck surgery. Another type of surgery utilized in rheumatoid arthritis patients is joint fusion or arthrodesis. In this procedure, affected bones are fused together. It is usually consider a last resort as range of motion is drastically reduced (Hospital for Special Surgery).⁴ Arthroplasty, or joint replacement, involves the partial or complete removal of a damaged joint and the use of artificial joints (American College of Rheumatology).⁵ Joint replacement is common in knees and hips.

Much RA-related surgery is conducted by orthopedic surgeons who specialize in the musculoskeletal system. Within the ranks of orthopedic surgeons, there are many subspecialties with some focusing on knees, hips, the spinal system, shoulders, etc. My upcoming elbow surgery is being conducted by an orthopedic surgeon who focuses primarily on the hand and elbow.

Depending on the surgical process, numbing medications and/or anesthesia will be used. General anesthesia is a wonderful thing in that nothing is consciously experienced during surgery. There are some inherent risks involved with these medications that are explained prior to surgery by an anesthesiologist who will be present during the surgery. Some people experience nausea but additional medications can be used to lower those side effects. It can take several days for the effects of anesthesia to completely wear off and it may feel like you’re in a fog for a while.

Rest is critical to recovering from the trauma caused by surgery. This can be challenging for type A personalities like myself. Narcotic pain medications are important for the healing process and helping the body rest. Don’t be afraid to take them on a regular timed basis and don't wait until the pain intensifies as this will help keep pain in check. Narcotics can cause constipation so it may be helpful to increase water intake and fiber content and to use laxatives. Physical therapy is often prescribed after surgery to assist in recovery in order to reduce pain, restore function and build strength.⁶

Since RA patients may have a weakened immune system from medications, there is an increased risk of infections from invasive procedures like surgery. The surgeon will work with your rheumatologist on developing a schedule for stopping and resuming immune suppressing medications.

Hopefully you will never need surgery if you’re suffering from RA. But if you do, seek out a reputable and board certified surgeon, get a second opinion if needed, understand the procedures recommended, take pain medications, and give yourself time to recover. While surgery can be intimidating, it can help with reducing RA pain and increase movement and joint function.