After being diagnosed with rheumatoid arthritis of the hands and feet, now I find out I have it in the neck, too. The doctor is talking surgery. I'd really like to avoid any operations. Is there any way to tell if I'd be a good person to have surgery? Maybe I would do better with just exercise.

Researchers are working very hard to identify patients with RA who need surgery and who would have a good result after an operation. Doctors from Tufts University in Boston been able to come up with a list of at least eight signs that a patient needs surgery.

Most of these are from findings on X-rays. The most common are: 1) neurologic signs and symptoms that are getting worse instead of better, 2) severe, constant pain, and 3) neck instability. The others are based on measurements made from the X-rays showing location of bones and joints and any changes in their spacing.

Once a patient is advised to have an operation it's best to follow through. Patients with the best preoperative function seem to have the best results from this type of surgery.

You may want to try a conservative approach with nonsurgical treatment first. If you do and your symptoms don't improve, it may be best not to wait more than six months before rethinking the surgical options.

David H. Kim, MD, and Alan S. Hilibrand, MD. Rheumatoid Arthritis in the Cervical Spine. In Journal of the American Academy of Orthopaedic Surgeons. November 2005. Vol. 13. No. 7. Pp. 463-474.

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