Meta Analysis on Medical and Surgical Management and Rehabilitation in Rhematoid Arthritis

Abstract

Background: Rheumatoid arthritis (RA) is a systemic, chronic, autoimmune disorder, which is characterized by persistent synovial inflammation, progressive destruction of joints and marked functional impairment. A significant number of patients still report irreversible structural damage, pain, and poor quality of life despite significant improvements in the disease control due to the improvement in disease-modifying antirheumatic drug (DMARD) therapy. This has brought the need to have integrated management approaches with an emphasis that is not limited to pharmacological treatment. Purpose: This was a systematic review and synthesis of evidence of medical, surgical and rehabilitation interventions in rheumatoid arthritis, in the context of their combined effects on pain and functional outcomes, complication rates and health-related quality of life. Methods: A meta-analysis and systematic review were done as per the PRISMA 2020 guidelines. They were searched in electronic databases such as PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar that used peer-reviewed articles published between January 2010 and December 2025. The studies that were eligible were systematic reviews, meta-analyses, randomized controlled trials, and high-quality observational studies carried out on adult patients with RA. Intervention of interest included pharmacological intervention, surgery and rehabilitation measures. Random-effects meta-analysis were applied to extract and synthesize data where the quality of the studies was assessed with validated appraisal tools. Findings: 58 studies were incorporated in the qualitative synthesis and 15 studies were used in the quantitative meta-analysis. Essential taping of the activity of the diseases with the help of the early introduction of csDMARDs and their further increase to biologic or targeted synthetic agents was accompanied by considerable disease activity, radiographic progression, and the chances of having a joint replacement surgery. Surgical procedures, such as total knee and hip arthroplasty and spinal surgery, resulted in great pain relief and functional improvement but also had more complication rates among RA patients than those of the osteoarthritis population. Rehabilitation interventions, especially biopsychosocial and technology-assisted interventions, were found to have a high degree of benefits in terms of pain, functional recovery and quality of life. The use of integrated management approaches that involved optimization of medicine, surgery as well as rehabilitation brought about cumulative improvements in major clinical outcomes. Conclusion: The current meta-analysis results highlight the significance of the multidisciplinary and integrated strategy of managing rheumatoid arthritis. Integrating convenience pharmacological treatment and timely surgical intervention with more advanced rehabilitation plans can result in the highest potential to decrease disability and improve functional results and quality of life of RA patients.