Background Total knee arthroplasty (TKA) is used as a part of the treatment of the rheumatoid arthritis (RA) all over the world. It can provide pain and restoration of mobility for knee arthritis. Although there are a few studies 1,2 concerning influences of TKA on general disease activity and activity of daily living (ADL) in patients with RA, more information is needed.
Objectives This retrospective study determined influence of TKA on various parameters about local and general disease activity in patients with RA.
Methods The subjects used in this study were 22 RA patients undergoing TKA. Patients' characteristics at operation were investigated. Disease activity of RA and quality of life (QOL) were measured using the DAS28-CRP, SDAI, and the modified health assessment questionnaire (mHAQ) at baseline, 3 months, 6 months and 12 months. The components of DAS were also evaluated (tender joint conts (TJC), swollen joints counts (SJC)). CRP (mg/dl), ESR (mm/hour) and MMP-3 (ng/m) were used as clinical laboratory data. We also analyzed the change of the drug used to treat RA, such as methotrexate (MTX), prednisolone (PSL) and biologics.
Results Patients were all female with an age mean of 62.4±9.3 years old. Mean RA duration was 16.7 years. Mean DAS28-CRP was 3.4 at baseline, 2.2 at 3m, 2.1 at 6m and 1.9 at 12m. Significant improvement was found after 3m. Mean SDAI was 16.4 at baseline, 7.4 at 3m, 7.9 at 6m and 6.9 at 12m. Significant improvement was found after 3m.In VAS, the improvement and the statistical significant difference of the mean were found in all items (pain, general and physician). TJC was 4.8 at baseline, 2.1 at 3m, 1.9 at 6m and 2.0 at 12m. SJC was 2.5 at baseline, 0.6 at 3m, 0.7 at 6m and 0.5 at 12m. Significant improvement was found after 3m in TJC and SJC, not only in TJC and SJC in lower limbs but also that in upper limbs.mHAQ (0.89 - 0.50 - 0.59 - 0.52) was significantly improved after 3 months, and there were the statistical significant differences between at baseline and at 12m in 5 activities (arising, walking, hygiene, reach and common daily activities) (Fig1.). Although there were no significant difference in CRP and ESR between at baseline and after operation, MMP-3 (272.6 to 130.9) showed an significant improvement after TKA until 1 year (272.6 – 178.5 – 88.5 -130.9).In addition, in MTX and PSL used, the meaningful change was not found in MTX dosage and PSL dosage between before TKA and after TKA.
Conclusions In this study, it was suggested that TKA was associated with improvement in disease activity and QOL in patients with RA. In the evaluation of the disease activity, an significant improvement was found in composite measures such as DAS28 and SDAI. In addition, singnificant improvement of MMP-3 can be expected after TKA probably due to synovectomy in operated knee. TKA improved not only local but also general disease activity and it was a useful option in the “treat to target” concept
Yano et al. Mod Rheumatol 2010.
Hayashi et al. Mod Rheumatol 2012.
Disclosure of Interest None declared
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