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Long-term treatments cause significant side effects, and alternative drugs exist.

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The two drugs appeared to be similar alternatives for maintaining remission; however, our observations do not provide support for the working hypothesis that methotrexate would have a better toxicity profile than azathioprine.

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If a radiologist reviews the X-rays and feels that the arthritis is erosive and is likely to be rheumatoid arthritis or canine idiopathic erosive arthritis, then I am not sure why surgery would be contemplated, unless it is surgery to stabilize the joint through arthrodesis (fusing the joint) --- which may be helpful in the case of idiopathic erosive polyarthritis.

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