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Artritis inflamatoria y reumatoide

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Rheumatoid, psoriatic and gouty arthritis affecting the hand, wrist and upper limb — what they are, how they are managed, and when surgery helps.

Updated Sep 2026
Una mano con articulaciones de los nudillos hinchadas.
La artritis inflamatoria afecta el revestimiento articular, provocando hinchazón, rigidez y, si no se trata, daño articular. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

Qué está experimentando

La artritis inflamatoria, incluida la artritis reumatoide, es una enfermedad en la que el sistema inmunitario ataca el revestimiento de las articulaciones. Esto provoca hinchazón, dolor y rigidez, a menudo en varias articulaciones al mismo tiempo. El mismo proceso patológico puede afectar el hombro, el codo, la muñeca, la cadera, la rodilla o el tobillo.

El dolor suele ser más intenso por la mañana y puede disminuir a medida que se mueve durante el día. El descanso puede calmar una crisis, pero la rigidez suele reaparecer tras permanecer sentado durante un rato. Muchas personas notan que sus síntomas aparecen y desaparecen, con periodos de mayor tranquilidad entre una crisis y otra.

A medida que la enfermedad afecta a las articulaciones, las tareas cotidianas se vuelven más difíciles. Girar un picaporte, levantar una tetera, llevar la compra o levantarse de una silla pueden requerir más esfuerzo que antes. Caminar distancias más largas puede resultar incómodo si la cadera, la rodilla o el tobillo están afectados. Escribir, teclear o agarrar objetos pequeños resulta complicado cuando la muñeca o el codo se ven afectados.

También puede sentir los efectos de la enfermedad fuera de las articulaciones. Vivir con dolor y rigidez continuos puede influir en su estado de ánimo y nivel de energía, lo cual, a su vez, modifica la intensidad del dolor que experimenta día a día.

Si sus articulaciones se han deteriorado con el tiempo, la cirugía de reemplazo articular puede reducir el dolor y mejorar su funcionamiento. Esto aplica tanto al hombro, codo, muñeca, cadera, rodilla como al tobillo. La recuperación de la movilidad y la comodidad suele ser gradual, no instantánea, y se logra a partir del estado previo a la operación.

Dado que la artritis inflamatoria afecta todo el cuerpo y no solo las articulaciones, conlleva un riesgo ligeramente mayor de complicaciones postquirúrgicas en comparación con la artrosis por desgaste. Su médico hablará con usted sobre esto, así como sobre cómo sus demás medicamentos y condiciones de salud se integran en el plan de tratamiento.

¿Qué está ocurriendo realmente?

En una articulación sana, los extremos de los huesos están recubiertos de cartílago liso; este actúa como una almohadilla deslizante que permite que las superficies se deslicen una sobre la otra. Un fino revestimiento alrededor de la articulación produce un líquido que facilita el movimiento, algo similar al aceite en una bisagra.

En la artritis inflamatoria, el sistema inmunitario confunde este revestimiento con algo dañino y lo ataca. El revestimiento se inflama y produce exceso de líquido, por lo que la articulación se hincha y se siente rígida. Con el tiempo, la inflamación continua desgasta el cartílago y puede debilitar también los tendones, esos cordones que unen los músculos con los huesos. Por eso las articulaciones se sienten rígidas por la mañana, por qué aparecen y desaparecen los brotes inflamatorios, y por qué agarrar objetos o caminar se vuelve más difícil a medida que las superficies articulares se vuelven ásperas.

Dado que la enfermedad afecta a todo el cuerpo y no solo a una articulación desgastada, puede involucrar varias articulaciones a la vez y también influir en la fortaleza ósea y en la respuesta del organismo a las infecciones. Por este motivo, la cirugía en una articulación inflamada conlleva un riesgo ligeramente mayor de complicaciones que la cirugía para la artrosis por desgaste; también es por eso que el médico evalúa cuidadosamente los medicamentos y el estado general de salud del paciente antes de recomendar una intervención.

Cuando la articulación está muy dañada, la cirugía de reemplazo articular puede ser útil. Sustituir las superficies desgastadas por una prótesis elimina la fricción dolorosa. Las personas con artritis reumatoide a quienes se les ha reemplazado la cadera, la rodilla o el hombro suelen reportar menos dolor y una mejor funcionalidad posteriormente, de forma similar a lo que ocurre en pacientes con artrosis por desgaste.

Qué podemos hacer al respecto

Hay muchas cosas que usted mismo puede hacer. El ejercicio suave y regular mantiene las articulaciones en movimiento y protege el corazón y la salud en general. El entrenamiento de intervalos de alta intensidad y el ejercicio de fuerza, siempre bajo supervisión, son viables y bien tolerados por personas con artritis reumatoide bien controlada; por ello se pueden recomendar para mejorar la salud cardiovascular y física. La fisioterapia y la terapia ocupacional también pueden ayudarle a manejar las tareas cotidianas. Vale la pena probar estos métodos durante varias semanas antes de decidir si le resultan útiles.

En la artritis reumatoide temprana, los medicamentos desempeñan un papel fundamental. Los antiinflamatorios y los corticoides alivian el dolor y la inflamación. El metotrexato y los fármacos biológicos calman el sistema inmunitario que ataca las articulaciones. Los fármacos biológicos son proteínas producidas en laboratorio que generalmente actúan sobre un mensajero inflamatorio llamado factor de necrosis tumoral; han demostrado excelentes resultados en el tratamiento. Dado que debilitan el sistema inmunitario, aumentan el riesgo de infecciones, por lo que este efecto secundario debe discutirse con su médico. El manejo médico moderno ha supuesto una verdadera diferencia: entre 1995 y 2010, el número de prótesis articulares implantadas por artritis reumatoide disminuyó un 48 %, gracias a la mayor eficacia de los tratamientos médicos.

Si sus síntomas persisten siendo graves a pesar de estos tratamientos, su médico podría derivarle a un especialista para una evaluación. El médico analizará detenidamente sus medicamentos y su estado de salud general, ya que algunos fármacos deben suspenderse antes de una operación. Por lo general, los agentes inmunosupresores se interrumpen al menos una semana antes y una semana después de la cirugía; además, quienes toman corticoides suelen necesitar dosis adicionales de hidrocortisona en torno al momento de la operación. En algunos casos, cuando las articulaciones están muy dañadas, podría considerarse algún procedimiento quirúrgico.

Qué esperar

La artritis reumatoide es una enfermedad crónica; en la mayoría de las personas, los síntomas aparecen y desaparecen. Entre los brotes hay períodos de menor actividad, y la hinchazón y rigidez tienden a fluctuar en lugar de desaparecer por completo. Dado que afecta a todo el cuerpo, pueden verse afectadas varias articulaciones al mismo tiempo; sin embargo, las articulaciones pequeñas de las manos y los pies son las más frecuentemente afectadas.

Sin tratamiento, la inflamación continúa dañando las articulaciones. El daño articular suele comenzar durante el primer o segundo año y persiste a partir de entonces. Con el tiempo, esto se manifiesta como dolor al usar la articulación, y ésta puede ir cambiando de forma gradualmente. Por esta razón es tan importante el tratamiento temprano: los medicamentos administrados a tiempo pueden reducir la inflamación antes de que dañen las superficies articulares.

Con un tratamiento bien gestionado, el pronóstico mejora. Los medicamentos modernos pueden disminuir la hinchazón y frenar o prevenir daños adicionales; muchas personas mantienen una vida activa y cómoda durante años. Algunas personas alcanzan un estado en el que la enfermedad permanece inactiva, lo que los médicos denominan remisión. Si una articulación ya está muy dañada, la cirugía de reemplazo articular también puede aliviar el dolor y mejorar su funcionamiento, de forma similar a como ocurre en la artrosis.

Hay que reconocer que los resultados postquirúrgicos varían según la articulación. Tras un reemplazo de cadera, las personas con artritis reumatoide suelen reportar menos dolor y mejor funcionalidad, similar a lo observado en pacientes con artrosis; no obstante, presentan un riesgo algo mayor de complicaciones o de necesitar nuevas cirugías. Tras un reemplazo de tobillo, los pacientes con artritis reumatoide suelen experimentar menos mejoría en sus puntuaciones diarias que quienes padecen otros tipos de artritis, aunque aún mejoran respecto a su estado inicial. El reemplazo de muñeca ha mostrado buenos resultados que perduran 10 años después de la intervención. Su médico le explicará qué significa esto para su articulación específica.

Independientemente de la articulación, lo realista es esperar una mejora gradual a lo largo de semanas y meses, no una solución inmediata; esto se logra mediante cuidados médicos constantes, mantener el movimiento articular y recurrir a la cirugía únicamente cuando sea verdaderamente necesaria.

¿Cuándo consultar a un especialista?

La artritis inflamatoria es una afección que su médico de cabecera y el equipo reumatológico manejan a diario; por eso, la mayoría de sus consultas serán con ellos. Solicite una evaluación especializada si alguna articulación sigue dolorida, hinchada o rígida a pesar de los medicamentos que está tomando, o si ha cambiado de forma o dificulta considerablemente sus actividades cotidianas. Su médico de cabecera también puede organizar controles para determinar si su tratamiento actual está surtiendo efecto.

Acuda de inmediato a su médico de cabecera si nota calor, enrojecimiento o hinchazón en una sola articulación, y si el dolor es mucho más intenso que en sus brotes habituales; especialmente si siente fiebre o malestar general. Una articulación inflamada a veces puede infectarse, y eso requiere una evaluación sin demora.

Vaya a urgencias si tiene una articulación muy caliente, extremadamente dolorosa y con fiebre, y no puede obtener atención médica urgente de su médico de cabecera; o si se siente mal en general y observa que el enrojecimiento se extiende alrededor de la articulación.

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

  • 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

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

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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.