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Pamamaga at Rheumatoid Arthritis

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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 Aug 2026
Isang kamay na may pamamaga sa mga kasu-kasuan ng knuckle.
Ang inflammatory arthritis ay sumasakop sa lining ng kasukasuan, na nagdudulot ng pamamaga, katigasan, at, kung hindi gagamutin, pinsala sa kasukasuan. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Maaaring mapansin mong may katatagan at sakit sa iyong mga kasukasuan, lalo na kapag bago ka pa lang gumising. Ang katatagan sa umaga ay madalas na nagdudulot ng hirap sa mga simpleng gawain. Maaaring mahirap kang umabot sa likod ng iyong likod upang isara ang bra o itabi ang isang kamiseta. Ang pag-abot sa mga bagay sa mataas na mga shelf ay maaari ring maging hamon. Ang mga araw-araw na galaw na ito ay maaaring magdulot ng kaguluhan na nananatili sa buong araw.

Ang iyong sakit ay maaaring lumala pagkatapos kang maging aktibo. Ang pagpapahinga ay maaaring tumulong upang bawasan ang sakit, ngunit ang matagalang kawalan ng gawain ay minsan ay nagpapalala ng katatagan. Maaaring mahirap kang matulog sa iyong gilid kung apektado ang iyong balikat o balakang. Ang sakit ay maaaring magpansamantala sa iyong pahinga, na nag-iiwan sa iyo na pagod at nalulungkot. Ito ay isang karaniwang karanasan para sa mga tao na may inflammatory arthritis.

Mahalagang malaman na iba ang pagharap ng iyong katawan sa operasyon kumpara sa isang may wear-and-tear arthritis. Kung ikaw ay gagawa ng joint replacement, tulad ng para sa iyong siko, tuhod, o balikat, may mas mataas kang risk ng komplikasyon. Kasama rito ang mga medical issues at surgical problems. Mas malaki rin ang chance na kailangan mong magkaroon ng revision surgery sa hinaharap kumpara sa mga pasyente na walang inflammatory conditions.

Sa kabila ng mga risk na ito, maraming pasyente ang nakakakita ng malaking benepisyo. Pagkatapos ng total hip replacement, inaasahan mong babawasan ang sakit at mapapabuti ang function na katulad ng iba. Maaaring talakayin ng iyong surgeon ang mga opsyon tulad ng robot-assisted techniques para sa iyong tuhod upang matulungan ang pagpili ng pinakamainam na surgical method. Para sa iyong bukong-bukong, maaaring makaranas ka ng functional improvement mula sa iyong starting point, kahit na hindi gaanong malakas ang outcomes kumpara sa ibang uri ng arthritis.

Kung mayroon ka ring osteoporosis, ang kalusugan ng iyong buto ay isang priority. Maaaring irekomenda ng iyong care team ang mga treatment tulad ng denosumab upang mapanatili ang lakas ng buto at maiwasan ang karagdagang pinsala sa kasukasuan. Ang pag-unawa sa mga risk at benepisyo ay tumutulong sa iyong paghahanda para sa landas na nasa harap. Ang iyong surgeon ay magtatakda ng plano na angkop sa iyong partikular na pangangailangan at health profile.

Ano ang nangyayari talaga

Ang rheumatoid arthritis ay isang autoimmune condition. Ang iyong immune system ay maling sumasalakay sa lining ng iyong mga joint. Ang lining na ito ay tinatawag na synovium. Isipin mo ito bilang sleeve na nagbibigay cushion at lubrication sa iyong joint. Kapag naging inflamed ang sleeve na ito, ito ay namamaga at nagkakaroon ng pagkakapal. Ang prosesong ito ay nakakasama sa smooth coating sa mga dulo ng iyong buto, na kilala bilang cartilage. Ang cartilage ay gumagana bilang shock absorber. Kung wala ito, ang iyong mga buto ay magkaka-ubos sa isa’t isa. Ito ang nagdudulot ng sakit, stiffness, at pamamaga.

Ang inflammation na ito ay hindi nananatili sa isang lugar. Madalas itong nakakaapekto sa maraming joint sabay-sabay. Ang patuloy na irritation ay nagpapahina sa mga istruktura sa paligid ng joint. Ang mga tendon, na katulad ng matibay na lubid ng mga hibla, ay maaaring umunat o mabasag. Ang mga ligament, na nag-uugnay ng mga buto, ay maaaring magpaluwag. Ito ay nagdudulot ng joint instability at deformity sa paglipas ng panahon. Dahil systemic ang sakit, nakakaapekto ito sa buong katawan mo. Ito ang dahilan kung bakit maaaring maramdaman mong pagod o hindi magaling kahit hindi aktibong masakit ang iyong mga joint.

Ang pinsala na dulot ng inflammation na ito ay nagbabago sa paraan ng pagganap ng iyong mga joint. Sa ilang kaso, tulad ng sa osteoporosis, ang mga buto mismo ay nagiging mas mahina at mas fragile. Ito ay nagpapataas sa kanilang susceptibility sa mga pagkabasag. Kapag kinakailangan ang surgery, tulad ng joint replacement, kailangang isaalang-alang ng iyong surgeon ang mahinang tissue na ito. Ang inflamed na environment ay maaaring magtaas ng risk ng mga komplikasyon pagkatapos ng surgery. Halimbawa, ang mga pasyente na may rheumatoid arthritis ay maaaring harapin ang mas mataas na risk ng mga medical issues o impeksyon kumpara sa mga may wear-and-tear arthritis.

Sa kabila ng mga hamong ito, maaari pa ring maging napaka-epektibo ang surgery. Maraming pasyente ang nakakaranas ng malaking pagbawas ng sakit at pagpapabuti ng function. Ang iyong surgeon ay magtatakda ng prosedura ayon sa tiyak na pinsala sa iyong joint. Isaalang-alang nila ang kalusugan ng iyong mga buto at soft tissues. Ang layunin ay ibalik ang galaw at bawasan ang sakit. Kahit na mas mataas ang mga risk kumpara sa simpleng wear-and-tear, maaaring maganda ang mga resulta. Maaari kang mag-expect ng pagbawas ng sakit at mas magandang daily function pagkatapos ng mga prosedura tulad ng hip o knee replacement. Ang susi ay ang pamamahala ng underlying inflammation upang protektahan ang iyong bagong joint at ang iyong pangkalahatang kalusugan.

Ano ang inaasahan

Ang iyong prognosis ay malaki ang nakadepende sa kung aling kasu-kasuan ang apektado at sa uri ng arthritis na mayroon ka. Ang rheumatoid arthritis ay isang systemic na kondisyon na maaaring gawing mas kumplikado ang paggaling kumpara sa wear-and-tear arthritis. Sa maraming kaso, nagbibigay ang surgery para sa joint replacement ng malaking ginhawa. Inaasahan mong mababawasan ang sakit at mapabuti ang function pagkatapos ng mga prosedura tulad ng hip o knee replacement. Karaniwang katulad ang mga resulta na ito sa mga nakikita sa mga pasyente na may non-inflammatory arthritis.

Gayunpaman, maaaring magkaroon ng iba't ibang reaksyon ang iyong katawan kumpara sa isang may simpleng osteoarthritis. Halimbawa, ang shoulder surgery sa mga pasyente na may inflammatory arthritis ay may mas mataas na risk ng parehong medical at surgical complications. Mayroon ka ring mas mataas na risk na kailanganin ang revision surgery kumpara sa mga may primary wear-and-tear issues. Katulad nito, maaaring magresulta ang ankle replacement sa mas mahinang patient-reported scores kumpara sa ibang uri ng arthritis, bagaman karanasan mo pa rin ang functional improvement mula sa iyong starting point.

Kung mayroon kang osteoporosis kasama ang rheumatoid arthritis, kritikal ang pagpapanatili ng kalusugan ng buto. Ang mga gamot tulad ng denosumab ay makakatulong na pigilan ang karagdagang pinsala sa kasu-kasuan at suportahan ang iyong mga buto. Kung walang tamang pamamahala, tumataas ang risk ng mga komplikasyon. Ang inflammatory arthritis ay nagpapakita ng malaki't naiiba na risk profile para sa mga postoperative medical issues kumpara sa osteoarthritis.

Mahalagang maging tapat sa mga risk na ito. Habang nakakamit ng maraming pasyente ang magagandang resulta, dapat mong inaasahan ang mas maingat na landas ng paggaling. Ii-customize ng iyong surgeon ang iyong pag-aalaga upang tugunan ang mga partikular na risk na ito. Ang layunin ay pamahalaan ang sakit nang epektibo upang mabawi ang mobility at bawasan ang sakit, kahit na medyo mas hamon ang landas kaysa sa iba.

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

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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.