Hi sorry to hear your dad is having so much pain and problem. Rheumatoid arthritis can be a disabling and damaging disease. I tell patients that if our joints are houses then rheumatoid arthritis is like fire which can burn down the house. The medications are like fire fighters who put out the fire and makes sure the fire does not destroy the joint . If we are late in starting treatment sometimes the disease ends up damaging the joint before the disease is reduced by medications. The part that is damage ie.. part of the house that is burnt needs to be replaced and for that we need surgery. Hence pain in a joint in rheumatoid arthritis patient can be due to disease (in which case pain can be reduced by increasing dose of medications) or due to damage (in which case surgery is required).  however even in the second situation medications should be continued as disease (reactivated fire) can damage the repaired joint (can burn the repaired house).  So you need to review with Dr Arvind chopra or any other rheumatologist to decide whether pain for your dad is due to disease or due to damage. Based on the same we can decide which is the best way forward to help your dad. Please let me know in case I can be of any other assistance. www.rheumatologybangalore.com - Sharath