Background Total hip prosthesis is an effective method of relieving pain and improving function the hip in patients with rheumatoid arthritis (RA). Topical drug therapy remains the question of RA therapy in perioperative period.
Objectives To review the results of total hip prosthesis according to baseline disease activity and received therapy.
Methods Total hip prosthesis was used on 36 RA patients (32 women, 4 men) with a mean age of 49,5 ± 15,82 years. Disease duration at the time of surgery was 12,45 ± 5,53 years. High disease activity by DAS28 was observed in 10 patients (27.8%), moderate - in 19 (52.8%), low - in 7 (19.4%) patients, the mean DAS28 4,5 ± 1,7. At the time of surgery (before and after), 24 (66.7%) of the patients continued to take basic anti-rheumatic drugs (DMARDs) - (methotrexate 7.5-15 mg per week -15, leflunomide - 7, sulfasalazine - 2). 6 (16.6%) patients received biological therapy: infliximab - 2, adalimumab -1, rituximab - 3, which were canceled before the operation in accordance with the terms specified in the national guidelines. 19 (52.8%) patients received steroids, of which, in combination with DMARDs - 7 (19.4%). Before the surgery, in the postoperative period and after 6 months joint pain on a visual analogue scale (VAS), the activity of the disease - DAS28, functional capacity index HAQ have been evaluated
Results For 6 months after surgery VAS decreased by 2.5 times to 31,7 ± .19,4 mm (p <0.05), disease activity decreased (high - 4 (11.1%), moderate 17 (47.2%), low -15 (41,7%)), D DAS28 = 1,1 ± .0,7, HAQ index decreased from 1,63 ± 0,91 to 1,04 ± 0, 78 (p <0.05). VAS in patients receiving steroids alone (n = 12) was - 24,9 ± .18,6 mm, steroids + DMARD (n = 7) - 29,1 ± 19,7 mm, only DMARDs (n = 11) 34,8 ± 18,9 mm, biological therapy + DMARD (n = 6) 37,4 ± 20,8 mm. Activity decreasing - D DAS28 – did not depend from treatment. Functional capacity in patients in the group (n = 17), receiving DMARDs with or without biological therapy (D HAQ = -0,69 ± 0,34) compared to patients receiving steroids without basic therapy (n = 12) - D HAQ = -0,48 ± 0,31 was significantly better improved (p <0.05). Deep vein thrombosis complication was observed in one patient treated with steroids, the development of soft-tissue infection of the operated joint, required the use of antibiotics in one patient treated with steroids at the time of surgery.
Conclusions Total hip prosthesis is an effective way to improve functional capacity, to relieve pain and to reduce the activity of RA. Functional ability after surgery is higher in patients using DMARDs continuously and receiving biological therapy compared to patients receiving steroids.
Disclosure of Interest None Declared