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Rheumatoid Arthritis & Bone Fusions

By August 22, 2008 - 4:28pm
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Does rheumatoid arthritis lead to bone fusion?


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EmpowHER Guest

I am new to this website but I have had RA for 12 years and am on Simponi.
I have been on all of the others, but they stop working after some time. I like the fact that with the injectible pen it is easy to do. My insurance covers most of it and there is also patient assistance program.
debbie freiden

November 7, 2010 - 9:26pm
(reply to Anonymous)

Thanks for writing, Debbie. There are a few of us here with RA, including me. I'm currently on Enbrel after Remicade and Humira stopped working for me. We're so lucky these days to have more meds to choose from than we used to.

Please keep in touch!

November 8, 2010 - 7:31am

From my understanding, bones are not able to "fuse" together unless they are still in the growing phase (infants, for example). Bone fusing, or arthrodesis, is a treatment option that fuses bones together.

October 7, 2010 - 1:34pm
EmpowHER Guest

Can certain bones fuse due to RA or Spinal Stenosis?

October 7, 2010 - 10:39am
(reply to Anonymous)

Hi Anon

The bones don't really fuse per se, at least not in the complete way they would in a surgical fusion, but if in the case of spinal stenosis the vertebrae have a lot of friction and arthritis, they can form osteophytes (commonly called bone spurs) and these osteophytes can sometimes become very large and sort of naturally fuse vertebrae in a spot. Think of it like a long bone scar that reaches up to the next bone, if that makes sense.

This would not be a common situation. It is much more likely in ankylosing spondylosis, another autoimmune disease.

October 8, 2010 - 6:41am
HERWriter Guide

Hi Ang-

No, RA does not always require a fusion. Medications can suffice for some but it all depends on the progression of RA and where it affects the body the most. RA has a tendency to eventually affect almost every joint in the body. Fusions are fairly common, particularly spinal fusions. When RA affects the limbs, mobility is always an issue. When it attacks the spine, it can lead to paraplegia.

Here is a great overview from the University of Southern California's Canter for Spinal Surgery regarding fusions-

"When a patient with rheumatoid arthritis develops cervical instability and/or spinal stenosis with myelopathy, surgical intervention is considered. The goal of surgery is to stabilize the spine and remove the compression from the spinal cord, to improve a patient's pain and level of function, as well as prevent further deterioration of function and worsening pain. A patient with isolated cranial settling and/or atlanto-axial instability without cord compression can be treated with posterior (back of the neck) occipital-cervical fusion with instrumentation. However, patients with severe anterior (front of the neck) cord compression from a pannus at the C1-C2 joint will be indicated for a transoral decompression surgery combined with a posterior occipital-cervical fusion with instrumentation. Patients with subaxial subluxation may have instability or stenosis, or both. Treatment options vary depending on each patient's clinical and radiopgraphic presentation. Patients with subaxial instability may only require a spinal fusion. Patients with stenosis and myelopathy require surgical decompression, and often fusion as well. If the majority of pressure is coming from osteophytes in the front (anterior) of the spine, then an anterior corpectomy with strut graft and fusion may be considered. If the majority of the compression is occurring due to ligamentum flavum hypertrophy in the back part of the spinal cord, then a laminectomy or laminaplasty may be performed. Occasionally, patients with severe, multiple level stenosis and instability will require both front (anterior) and back (posterior) of the neck surgery to adequately decompress and stabilize the spine. Generally, a cervical spinal fusion will always be required and recommended in addition to the decompression component. Spinal instrumentation will typically be utilized to impart immediate stability and increase the fusion (bone healing and mending together) rate. There is a higher rate of improvement for rheumatoid patients with cervical instability and/or neurologic dysfunction treated surgically than those treated nonsurgically. However, careful preoperative evaluation and delicate perioperative and postoperative management is particularly important to ensure success and avoid complications."


With regard to ankle fusions, Orthogate has this to say -

"An ankle fusion actually removes the surfaces of the ankle joint and allows the tibia to grow together, or fuse, with the talus. There are operations for many joints in the body that surgically fuse the joint to control pain. Before the development of artificial joints this was the primary operation available to treat an extremely painful joint. In some cases, fusion is still the best choice.

For the ankle, a fusion is a very good operation for treating a worn-out joint. This is especially true if the patient is young and very active. An ankle fusion, if successful, is not in danger of wearing out like an artificial ankle. An ankle fusion should last the patient a lifetime. But it is also important that the other foot joints are normal. A fusion keeps the ankle joint from moving during walking and other activities, so the other foot joints will need good mobility. "


Many experts seem to believe fusions are one of the best ways to combat this chronic disease but a fusion is not always necessary. Many people live with RA using a combination of anti-inflammatory drugs and other therapies.

I hope this helps, Ang. How are you doing? Please give us an update.

August 23, 2008 - 7:20am

Hi Susan,

Your first question...does RA require a fusion in order to correct or treat RA?


August 22, 2008 - 8:13pm
(reply to angmares)

Hi Ang

Sometimes a fusion is the best treatment if you have had RA and have significant deformity, pain, and dysfunction. For example, if you have a lot of pain and instability in your wrist, and there is joint deformity that is permanent, sometimes a fusion makes the bones stop deforming further and because they no longer sort of rub each other the wrong way, it can decrease pain significantly.

These days if you get timely treatment for RA you avoid much of the permanent deformity that used to be common place. But if you have severe RA that does not respond well to meds, you may end up with deformities in spite of your best efforts. The fusion is just one treatment for severe pain and dysfunction in a joint. It would be done on a very individual basis.

I hope that helps. If you have further questions, please let me know. Not only am I a nurse, but I have had RA for about 25 years. Thanks for writing.

October 8, 2010 - 6:37am
HERWriter Guide

Hi Ang, thanks for your question.

I have a question back!

Do you mean does RA require (for example, a spinal fusion) in order to correct or treat RA? Or is your question asking if certain bones fuse DUE to RA?

Thank you!

August 22, 2008 - 5:32pm
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