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If a joint becomes suddenly hot, swollen and intensely painful with fever, seek care today. Distinguishing a flare from infection is urgent, particularly if you take immune-suppressing medication. Also seek urgent care for new neck pain with arm or leg weakness.

Home  /  Treatments  /  Joint replacement  /  Rheumatoid and inflammatory arthritis

Rheumatoid and inflammatory arthritis

An immune condition in which the body attacks the lining of its own joints. Unlike osteoarthritis it is a disease of the whole body, and the drug treatment matters far more than any operation.

Modern medication has transformed rheumatoid arthritis to the point that severe joint destruction is now much less common in patients treated early. If you are not on disease-modifying treatment, that is the first thing to address — before any surgery is discussed.

Clinically reviewed by Dr. Annie Varughese, Consultant Orthopaedic Surgeon Clinical oversight Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Treatment priority
Medication first
Disease-modifying drugs, started early
Surgery
For damage already done
It does not treat the disease itself
Neck
Must be checked
Before any general anaesthetic
Time in India
3 to 5 weeks
For joint replacement, plus rehabilitation
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What inflammatory arthritis is

In rheumatoid arthritis the immune system attacks the synovium, the lining membrane of the joints. The inflamed lining thickens, produces excess fluid, and progressively erodes the cartilage and bone at the joint margins. Unlike osteoarthritis it typically affects many joints symmetrically, most characteristically the small joints of the hands and feet, and it is accompanied by prolonged morning stiffness and general fatigue.

It is a systemic disease rather than a local one. It can affect the lungs, the eyes, the blood vessels and the heart, and it carries an increased cardiovascular risk that deserves attention in its own right.

Related conditions behave similarly — psoriatic arthritis, ankylosing spondylitis, and arthritis associated with inflammatory bowel disease. Each has its own pattern but the principle is the same: control the inflammation with medication and the joint damage largely does not happen.

This is the most important thing on this page. Disease-modifying drugs started early prevent the destruction that used to make joint replacement inevitable. Surgery deals with damage that has already occurred; it does nothing about the disease that caused it.

Symptoms

Symptoms and warning signs

Common symptoms
  • Pain and swelling in several joints, often symmetrical
  • Morning stiffness lasting more than an hour
  • Small joints of the hands and feet affected early
  • Fatigue and a general feeling of being unwell
  • Joint deformity developing over years
  • Nodules under the skin near the elbows
  • Dry eyes and mouth, or breathlessness, from involvement outside the joints
Warning signs of an emergency
  • A single joint suddenly hot, swollen and intensely painful with fever
  • Neck pain with weakness, numbness or clumsiness in the hands
  • New breathlessness or persistent cough
  • Sudden loss of vision or a painful red eye
  • Fever while taking immune-suppressing medication
  • Severe unexplained abdominal pain

Your neck must be assessed before any general anaesthetic

Long-standing rheumatoid arthritis can loosen the ligaments holding the top two vertebrae of the neck together. During intubation for a general anaesthetic, the neck is extended — and in an unstable cervical spine this can injure the spinal cord. Flexion and extension X-rays of the neck should be taken before any operation under general anaesthetic. This is standard practice in units familiar with rheumatoid patients and sometimes overlooked elsewhere. Ask about it explicitly.

Diagnosis

How it is diagnosed

Blood tests support the diagnosis; imaging shows the damage.

Initial tests

  • Rheumatoid factor and anti-CCP antibodies — anti-CCP is the more specific of the two
  • ESR and CRP — measure current inflammatory activity
  • X-rays of hands and feet — show erosions, which are the hallmark of established disease
  • Full blood count, kidney and liver function — needed before and during drug treatment

The deciding tests

  • Flexion and extension X-rays of the cervical spine — essential before general anaesthesia
  • Ultrasound or MRI of affected joints — detects inflammation and early erosion before X-ray change
  • Chest imaging and lung function — where lung involvement is suspected
  • Screening before biologic therapy — tuberculosis and hepatitis, which must be excluded first

Tell us exactly which drugs you take, and when you last took them

This matters more than in almost any other condition. Methotrexate, biologic drugs and steroids each affect surgery differently — some must be stopped before an operation and restarted afterwards on a defined schedule, because they increase infection risk and impair wound healing. Send the drug names, doses and dates. Getting this wrong causes wound problems and infections that are entirely avoidable.

Options

Treatment options

Medication controls the disease. Surgery repairs what the disease has already destroyed.

First

Disease-modifying medication

Methotrexate remains the foundation of treatment, with other conventional agents added or substituted. Where the disease remains active, biologic drugs targeting specific parts of the immune response are highly effective. Started early and used properly, these prevent most of the joint destruction that leads to surgery. They are available in India at a fraction of Western prices, which is itself a reason some patients travel.

Usually appropriate whenAlways, and as early as possible after diagnosis. This is the treatment; everything else is repair.
Option two

Joint replacement

Knees, hips and shoulders damaged by inflammatory arthritis are replaced using the same implants as for osteoarthritis, with some additional considerations — bone is often softer, soft tissues are more fragile, and infection risk is higher because of immune-suppressing medication. Results are generally good, and patients are frequently younger than typical osteoarthritis patients.

Usually appropriate whenA joint is destroyed and painful despite optimal medical treatment.
Option three

Hand, wrist and forefoot surgery

Tendon repair and transfer where tendons have ruptured, wrist fusion or replacement, correction of finger deformity, and forefoot reconstruction for painful toe deformity. Forefoot surgery in particular is often transformative for walking and is frequently overlooked in favour of larger joints.

Usually appropriate whenSpecific deformity or tendon rupture causing functional loss.
Option four

Synovectomy

Removing the inflamed joint lining, arthroscopically or open. It can relieve symptoms in a persistently inflamed joint where the cartilage is still reasonably preserved and medical treatment has not controlled that particular joint. Its role has diminished considerably as drug treatment has improved.

Usually appropriate whenOne or two joints remain persistently inflamed despite otherwise good disease control.
The decision

How the choice is made

Is the disease controlled?

Operating on a patient with active uncontrolled inflammation gives worse results. Getting the medication right comes first, and sometimes removes the need for surgery altogether.

Which joint limits you most

Rheumatoid patients often have several damaged joints. The sequence matters — upper limb surgery may need to come first if you will need crutches after lower limb surgery.

Medication timing around surgery

Biologics and methotrexate need managing on a defined schedule before and after an operation. This should be planned with your rheumatologist rather than improvised on admission.

If you are not on disease-modifying treatment, we will say so before discussing any operation. It is the treatment that changes your future, and it is inexpensive here.

Urgency

How urgent is your case

Usually safe to plan travel
  • Disease controlled on stable medication
  • Joint damage established and stable
  • No active infection
  • Neck imaging done and stable
Needs local assessment before travel
  • Hot swollen joint with fever, suspected infection
  • Active flare with high inflammatory markers
  • Fever on immune-suppressing medication
  • Neck instability with neurological symptoms
  • Untreated tuberculosis or hepatitis before biologics

We will tell you which column you are in

A single hot joint in a rheumatoid patient on immune-suppressing drugs must be assumed infected until proven otherwise, and needs assessment locally today.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • Full list of current medication with doses and last dates taken
  • Rheumatoid factor, anti-CCP, ESR and CRP
  • X-rays of the affected joints
  • Cervical spine flexion and extension films if available

Also helpful

  • X-rays of hands and feet
  • Recent full blood count, kidney and liver function
  • Any previous joint surgery
  • Whether tuberculosis and hepatitis screening has been done
Send my reports for review See published cost ranges
Questions

Questions patients ask

No. Surgery replaces or repairs joints the disease has already damaged. It does nothing to the underlying immune process, which continues and can damage other joints. Disease-modifying medication is what treats the disease, and it is the single most important part of your care.

This should be decided with your rheumatologist rather than assumed. Practice varies — methotrexate is often continued through joint replacement, while biologic drugs are usually stopped for a defined period before surgery and restarted once the wound has healed. Getting the schedule right reduces infection risk without letting your disease flare.

Because long-standing rheumatoid arthritis can loosen the ligaments at the top of the neck, and the neck is extended during intubation for a general anaesthetic. In an unstable cervical spine that manoeuvre risks spinal cord injury. Flexion and extension films identify the problem so the anaesthetist can plan for it. It is a small test that prevents a catastrophic complication.

Yes, somewhat — because of the disease itself and because of the medication that controls it. This is manageable with careful drug timing, treating any dental or skin infection before surgery, and strict antibiotic and theatre protocols. It is a reason to choose the hospital carefully rather than a reason to avoid surgery.

Yes, and at substantially lower cost than in Europe or North America, including biosimilar versions of several major agents. For some patients the medication itself is the reason to travel — a consultation, appropriate screening, and establishing a treatment plan can be arranged, with the drugs then continued at home.

Sometimes, and hand surgery in rheumatoid arthritis is a specialised area. Tendon ruptures should be repaired promptly because delay makes repair harder. Deformity correction, wrist procedures and forefoot reconstruction can substantially improve function. Send photographs of your hands along with the X-rays.

RelatedOn this site
Joint replacement in IndiaRead → Knee osteoarthritisRead → Ankylosing spondylitisRead → Joint replacement costRead → All treatmentsRead →
Contact

Send us your reports

Send your current medication list with doses, recent inflammatory markers, and X-rays of the affected joints. The drug list matters as much as the X-rays.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

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