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THU0092 The Long-Lasting Benefits of Upper Extremity Surgery for Disabled Patients with Rheumatoid Arthritis
  1. C. Okura1,2,
  2. H. Ishikawa2,
  3. A. Abe2,
  4. T. Oyakawa2,
  5. Y. Miyagawa2,
  6. H. Otani2,
  7. D. Kobayashi2,
  8. S. Ito2,
  9. K. Nakazono2,
  10. Y. Yonemoto1,
  11. K. Okamura1,
  12. T. Suto1,
  13. A. Murasawa2,
  14. K. Takagiishi1
  1. 1Orthopaedics, Department of Orthopaedic Surgery Gunma University Graduate School of Medicine, Maebashi
  2. 2Rheumatology, Niigata Rheumatic Center, Niigata, Japan

Abstract

Background The treatment of rheumatoid arthritis (RA) has made significant advances in the last decade, because of the introduction of biologics and the development of “Treat to Target (T2T)” treatment modalities. However, while the ADL of such patients have improved and the level at which patients can use their upper limb functions has increased, there have been few reports of postoperative long-term results of upper extremity surgery in RA patients.

Objectives To investigate a long-lasting effect of upper extremity surgery on patients with RA, a questionnaire survey was conducted.

Methods A questionnaire was sent to 89 RA patients who underwent upper-extremity surgery between January 2002 and December 2003. It inquired about the present condition of the surgically treated site, the satisfaction level, and reasons why the patient was satisfied or not. Acceptable replies were obtained from 68 patients (76.4%, mean age at surgery 57.5), regarding 98 sites (shoulder: 1, elbow: 20, wrist: 46, thumb: 16, fingers: 15). The surgical procedures included total elbow arthroplasty in 13 patients, wrist synovectomy and a Darrach procedure in 35 patients, Radiolunate arthrodesis in 17 patients, Swanson implant arthroplasty at the metacarpophalangeal joint in 26 patients, and so on.

Results The mean DAS28-ESR(4) at the time of surgery was 4.51, and it significantly decreased to 2.89 at present (P<0.01). Grip power increased from 158mmHg to 180mmHg in the patients who received wrist surgeries (P=0.049). The modified health assessment questionnaire (mHAQ) showed an improvement trend compared with the time of surgery, but no significant reduction was observed. However, when we compared only the items that evaluated the upper extremity function (items 1, 3, 5, 7) among the items of mHAQ, then a significant decrease was observed in the postoperative level 0.64 in comparison to the preoperative level 0.86 (P=0.02).

Regarding usefulness, 85.6% of the patients answered “better” than the preoperative condition. Regarding the satisfaction level, 85.5% answered “highly satisfied” or “satisfied”. The level was relatively high regarding the wrist (88.9%) and the fingers (93.8%) compared to the elbow (77.8%) and the thumb (81.3%). The most frequent reason for being satisfied was “pain relief” at all sites. The reason for not being satisfied was a “decrease in power” in the elbow and the thumb, and a “decrease in motion” in the wrist. In the thumb and the fingers, an “improved appearance” was a frequent reason for being satisfied.

Conclusions A long-lasting favorable effect was thus found in RA patients that underwent upper extremity surgery.

Disclosure of Interest None declared

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