Background In the elbow joints of RA patients with advanced bone destruction, pain is often accompanied with joint instability, restricted range of motion, and rigidity. In these cases, total elbow arthroplasty treatment is used. However biologics have been shown to improve patients' disease activity scores, there are extant cases of long-term RA sufferers with joint dysfunction accompanied with bone destruction. In the patients treated with biologics, the efficacy of the total elbow arthroplasty is not clear.
Objectives This study examines the effects of total elbow arthroplasty (TEA) on the post-operative disease activity, HAQ, and Mayo Elbow Performance Score (MEPS) of RA patients treated with biologis.
Methods From 2006 – 2013, there were 19 cases in which TEA was implemented at this clinic for RA patients taking biologics. All cases used the FINE Total Elbow System. Clinical evaluation of these procedures was performed through the examination of patients' blood biochemistry and disease activity scores. Disease activity was evaluated using DAS 28-ESR and CDAI. Joint dysfunction was evaluated prior to and after the procedures using HAQ, MEPS, and range of motion.
Results Patients' average age was 61.1 years, and average disease duration was 26.2 years. The biologics used were ETN (11 patients), TCZ (5), IFX (1), and ADA (2). In addition, MTX was used by 38.9% of patients, with an average dosage of 6.3 mg/week, and PSL was used by 44.4% of patients, with an average dosage of 1.7 mg/day. Blood biochemistry findings showed a significant reduction of MMP-3 levels, from an average of 125.4 (ng/ml) prior to surgery to 61.3 (ng/ml) afterward. HAQ-DI was also significantly improved, with values dropping from 2.0 to 0.4. Total elbow arthroplasty affected not only arm function, but also lower body function, with improvements in data related to arising and other activities. MEPS showed significantly improved scoring in pain, motion, stability, and function data. Total scores were markedly improved, increasing from 50.6 prior to surgery to 96.3 after the procedures. Significant improvements were observed in range of motion (from -38.2° to -20°), flexion (from 112.9° to 134.7°), and pronation (from 68.3° to 78.2°).
Conclusions CDAI and DAS 28-ESR disease activity scores improved from moderate prior to surgery to low activity afterward. In the course of total elbow arthroplasty, satisfactory supportive range of motion was restored to patients' elbow joints. This restored mobility, in addition to synovectomy performed in the surrounding areas during surgery, reduced the severity of synovitis conditions in related joints. The disease activity score improvements seen may be a result of this synovitis reduction. In addition, the elbows are a load-bearing joint for RA patients, and this may be the reason that HAQ showed improvements in both upper limb and lower body functions, including rising and other activities.For RA patients taking biological drugs, total elbow arthroplasty could both decrease disease activity scores and improve both upper and lower body function. The combination of pharmaceutical drugs, control, and surgical treatments is effective in improving disease activity scores as well as the mobility and bodily function of RA patients.
Disclosure of Interest None declared