Orthopaedic rheumatology is joint care for people with inflammatory arthritis, shared between a rheumatologist, who controls the disease with medication, and an orthopaedic surgeon, who treats joints and tendons already damaged.
Modern drugs have made surgery much less frequent in rheumatoid arthritis than a generation ago. When an operation is needed, the timing of immune suppressing medicines, fragile skin and bone, and neck involvement require special planning.
Conditions this service looks after
- Rheumatoid arthritis
- Psoriatic arthritis
- Ankylosing spondylitis and axial spondyloarthritis
- Gout and pseudogout with joint damage
- Juvenile idiopathic arthritis in adults
- Lupus related joint and tendon problems, and avascular necrosis from steroid use
- Rheumatoid hand and forefoot deformity
- Tendon ruptures at the wrist
Tests you may be offered
- Blood tests: Rheumatoid factor, anti-CCP, CRP, ESR, uric acid, HLA-B27 as appropriate.
- Joint fluid analysis: Distinguishes gout crystals, infection and inflammation.
- X-rays of hands, feet and affected joints: Show erosions and joint space loss.
- Ultrasound or MRI: Detect active synovitis and early erosions.
- Neck X-rays in flexion and extension: Check for instability of the upper cervical spine before any general anaesthetic in long standing rheumatoid arthritis.
- Bone density scan: Osteoporosis is common with inflammation and steroids.
Treatments available
- Disease modifying drugs and biologics: Prescribed and monitored by the rheumatologist; the foundation of care.
- Joint and tendon sheath steroid injections: Settle a persistently inflamed joint.
- Synovectomy and tenosynovectomy: Removal of inflamed lining to protect tendons, now needed less often.
- Joint replacement: Hip, knee, shoulder, elbow and finger joints destroyed by inflammation.
- Forefoot reconstruction: Fusion of the big toe joint with correction of the lesser toes.
- Wrist and hand surgery: Wrist fusion or stabilisation, tendon transfers after rupture.
- Cervical spine stabilisation: For rheumatoid instability threatening the spinal cord.
- Perioperative medicine planning: Most biologics are paused for about one dosing cycle before surgery and restarted when the wound has healed; methotrexate is usually continued.
When to ask for a specialist opinion
- Joint swelling and morning stiffness lasting more than an hour for over 6 weeks
- A single joint that stays swollen despite good overall disease control
- Sudden inability to straighten fingers, suggesting tendon rupture
- Deformity or pain that limits walking or hand use
- Neck pain with tingling or clumsiness in the hands in long standing rheumatoid arthritis
Travelling to Türkiye for this care
Inflammatory arthritis needs lifelong monitoring with regular blood tests, so ongoing medical care belongs with a rheumatologist near home. A visit can offer a second opinion on diagnosis or drug options, or a planned operation such as joint replacement or forefoot reconstruction. Bring a full medication list with dates of your last biologic dose, and agree the pause and restart plan with both teams before booking flights. Infection risk is higher on these medicines, so wound follow-up at home must be reliable.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
Should I stop my biologic before surgery?
Usually surgery is timed at the end of a dosing interval and the drug is restarted about 2 weeks later if the wound is healing. Never stop or change medicines without your rheumatologist's advice.
Is joint replacement riskier with rheumatoid arthritis?
Infection and wound problems are somewhat more frequent, while pain relief is just as good.
Can surgery cure my arthritis?
No. It repairs damage in one joint. Disease control depends on medication.