Is surgery a treatment option for RA?
Surgery can be very helpful in certain cases of RA. It is not for everybody, however, since any surgery involves risks. The doctor has to measure those risks in each case.

How are you considered for surgery?
A preoperative evaluation has to be completed by your doctor. The patient must be told the benefits of having surgery, and a good doctor will also let the patient know the downside of the surgery.

Is there anything that I should do before having surgery?
Yes, you should consider all the options and already have tried drug therapy, rehabilitation therapy, and modification of your daily activities to maximize your benefits.
If you have been on cortisone, you need to take a stress test before and during your operation. The adrenal glands of those people who have been on cortisone may not be able to cope with the stress of the surgery.

What are the biggest risks?
The RA patient presents a risk for nerve injury either before or during surgery, and this must be considered. Many RA patients are also at risk for infection in their joints either because of drug therapy or because of their poor state of health. The biggest risk occurs with patients with RA of the neck or, more specifically, at the base of the skull. Such patients run the risk of total paralysis during surgery because of hyperextension of the neck during any procedure. The patient with this kind of disease has to be evaluated carefully, and the spine has to be made stable before the surgery.

How do I avoid this problem?
Ask your doctor. The doctor usually performs a complete neurological evaluation as well as extensive X-rays before surgery.

What are some other concerns?
If your doctor plans to replace or surgically correct many of your joints, he or she must plan the repair of the joints in order to maximize your ability to recuperate. A rheumatoid foot, for example, should be repaired before the knee to permit the foot to be used for rehabilitation on the knee.
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Many of today’s medicines and drugs originated as natural substances. In some instances so-called savages in the jungles of South America were able to treat diseases in their tribe which all the medical techniques of our ‘civilized’ world could not help one bit. No doubt this still happens, but to a lesser degree, thanks to modern exploration and research techniques.

The process by which some drugs have evolved is governed to a certain extent by economics and commercialism, not always with the best results. Suppose it was discovered that some ethnic group were found to be treating a medical disorder with a certain substance found in, say, the fluid from the bubbles of seaweed. This would not do at all for our society, so our researchers would set to and try to establish what it was in the fluid that gave the therapeutic effect. They might be lucky and find that it seemed to be one particular ingredient. The next move would then be to try and make this ingredient synthetically. If this effort was successful then the synthetic material would be prepared and used. It would probably also be put forward for registry as a drug and, since it could be identified and prepared in a consistent way, would probably be accepted. It is, of course, quite probable that the synthetic preparation would not work as well as the original fluid taken from the weed. It is also quite likely that the synthetic material would show side-effects which did not occur with the original natural substance. This is not an unusual finding in this field of work.

The other possibility, of course, is that the researchers may find that they could not isolate any active ingredient from the fluid. They might find that the crude fluid was effective but attempts to break it down into groups or individual constituents resulted in a loss of activity. This is what happens with the mussel extract. If this was the case, it would be quite possible that the safety and effectiveness of the fluid could be demonstrated but that it could not be accepted as a drug.

Not all synthetic preparations are inferior to their natural counterparts. However, there is little doubt that, in general, a substance present in a combined form produced by nature is more effective than the same substance prepared synthetically and in isolation. In many instances it is the combination form of a substance that is responsible for the activity. The actual material on its own is ineffective.

Other aspects also come into play when a comparison between the reaction of a chemical compound produced synthetically and the same compound present in a natural’ substance is made. There are circumstances in which the same chemical compound will show very different reactions. The reasons for variances like this are several. Amongst them is the different physical form of the molecular structures in the two circumstances. This can result in the reactions of the same material being very different in natural and synthetic forms. Another factor would be the change in the distributive nature of the compound under the two circumstances.

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