Background Even now, in clinical practice, most of RA patients have long-standing disease and structural damage in their joints. Reconstructive surgery should be needed for further improvements of physical function for the patients. We know the importance of target for treatment. We conducted a multicenter prospective study in Japan, supported by the Ministry of Health, Labour and Welfare to set the treatment goal of joint reconstructive surgery.
Objectives The purpose of this study is to explore the characteristics of functional impairment including range of motion (ROM) of joints in patients who were needed joint surgery using baseline data of the prospective study.
Methods We started the study in September, 2012 (Study registration: UMIN000012649). We collected data on age, sex, disease duration, drug therapies, and disease activity. Functional evaluations were made using the HAQ-DI, DASH (Disability of Arm, Shoulder and Hand; upper limb function), and JSSF-RA (foot and ankle function), and patient subjective evaluations using the EQ-5D (comprehensive assessment of QOL) and BDI-II (depression). ROM was also measured as part of this evaluation.
Results 347 surgical patients were registered. Mean values for age (65.2 years), disease duration (18 years), and sex (88% female) were recorded. About half of enrolled patients had remission or low disease activity (median values for DAS28; 3.0 and CRP; 0.33 mg/dl). 61% had received MTX, while 23.8% of the patients were treated with biologics. 47.5% of the patients were performed upper limb surgery, and 51.5% required lower limb surgery. We confirmed the significant correlation between EQ-5D and HAQ-DI (P<0.05). Assistive use of upper limb was required for arising, climbing stairs, standing up from the sofa, and walking outside by 52%, 51%, 44%, and 29% of patients, respectively. We found significant relationship between ROM in upper limb (shoulder, elbow and wrist) and the level of disability in Question 2 (shampoo hair), Q4 (arising), Q11 (tub bathing), and Q16 (opening and closing a wide mouth jar) among the components of HAQ-DI. Following ROMs of the joints which represented nearly non-existent levels of disability, are needed; wrist; flexion-extension 60°, pronation and supination 150°, elbow; flexion 130°, and shoulder; flexion 140°. As for the joints in lower limb, we also found the relationship in Q4, and Q11. The cut-off of ROM of ankle, knee and hip joints by nearly non-existent levels of disability were as follows; ankle; flexion-extension 55°, knee flexion-extension 120°, hip flexion-extension 120°(Fig. 1A, B). To gain the ROM is important target of joint surgery. Treatment goal of surgical procedure could be set based on range of motion as well as reducing pain. It will be validated by longitudinal data in near future.
Conclusions Upper limb function based on ROM in RA patients who required surgical procedures was significantly associated with many kinds of daily activity. The information should be important for assessment of disability in patients with long-standing RA.
Disclosure of Interest None declared