Some people with rheumatoid arthritis require surgery to reconstruct or replace a damaged joint. Surgery is usually recommended when drug treatment alone can no longer improve the situation. The right time for surgery is a matter of judgment — yours and your health care provider's. Surgery is usually viewed as a last resort to reduce pain and/or improve function. (However, some hand surgeons advocate early surgical intervention to remove inflamed tissue and to help protect the joints and nearby tendons.)
The most common surgical procedures for rheumatoid arthritis are synovectomy (removal of the inflamed tissue that lines the joint) and arthroplasty (meaning joint repair, including joint replacement). The choice depends, in part, on which joints are involved, how severe the damage is, and whether you have any other medical problems. Total joint replacement, most commonly for severe hip or knee arthritis, is a major operation (that is, it requires general anesthesia and admission to the hospital); the associated risks must be taken into account.
Arthroscopy — another type of surgery for rheumatoid arthritis — is considered a more minor operation (that is, you can usually go home the same day). In arthroscopy, a tube is inserted into the joint through a small (anesthetized) incision. The tube has a tiny light, camera and a variety of attachments that can be used to visualize and smooth over or remove ragged edges around the joint, debris and inflamed tissue.