A scientific basis for surgery in rheumatoid arthritis.

Understanding a disease process provides the scientific basis for specific treatment. In rheumatoid arthritis (RA), disease(s) of unknown cause, the lack of knowledge about the intrinsic involvement of the articular collagenous tissues (ACT) as a site for the deposition and persistence of immune complexes may have led to poor long-term results of surgery, especially synovectomy. Because we may now presume that immune complexes in ACT provide inflammatory, immune foci for chronic synovitis, ablative surgery of the damaged cartilaginous tissues is a specific remedy. Such knowledge may be used judiciously with techniques of fusion, resection, and arthroplasty to improve and maintain the long-term function of patients with the crippling seropositive form of the disease.