Background By the biologic treatment of rheumatoid arthritis (RA), uncontrollable synovitis in the past has been well comtrolled. However, some patients with established RA are still difficult to reach comprehensive disease control, thus surgical reconstruction for the damaged joint is required. Recently, patients desired to achieve functional remission aiming at the higher level of quality of life (QOL) and the mental wellness.
Objectives The objective of this study was to clarify the effect of orthopedic surgical intervention for the disabled patients with RA using the assessment of patient-reported outcome (PRO) and disease activity.
Methods Surgical reconstruction of the damaged joint was scheduled on 276 sites in 276 patients (male: 34, female: 242) with RA between October 2012 and September 2014. The average age was 64 (19–89) years old and the average duration of the disease was 16 (1–60) years. The surgical site was shoulder in 6 patients, elbow in 26, wrist in 74, hand in 63 (combined with wrist in 18), hip in 13, knee in 50, ankle in 12, and forefoot in 50. The procedure included alloarthroplasty (shoulder: 5, elbow: 22, hand: 36, hip: 13, knee: 47), arthroplasty without prosthesis (wrist: 30, hand: 10, forefoot: 67), arthrodesis (wrist: 37, hand: 33, ankle: 11, forefoot: 5), and synovectomy (shoulder: 1, elbow: 4, wrist: 15, hand: 6, knee: 3, ankle: 1). MTX was used in 176 patients (64%) with the average dose of 7.7mg/w, and PSL was used in 175 patients (63%) with the average dose of 4.0mg/d. Biologics was used in 69 patients (25%) including ETN: 20, TCZ: 17, IFX: 11, GLM:9, ADA: 8 patients. PRO was assessed by Health Assessment Questionnaire-Disability Index (HAQ-DI), EuroQol-5 Dimensions (EQ-5D), Beck Depression Inventory-II (BDI-II), and patient's general health using visual analogue scale of 100mm (Pt-GH). Disease activity was assessed by 28-joint Disease Activity Score using C reactive protein (DAS28-CRP). They were measured just before surgery (baseline), at 6 and 12 months after surgery.
Results As a whole, physical function (HAQ-DI), QOL (HAQ-DI, EQ-5D, Pt-GH) and mental wellness (BDI-II, Pt-GH), disease activity (DAS28-CRP) significantly improved at 6 and 12 months after surgery compared to those at baseline (p<0.01) (Table1, Figure1). The rate of clinical remission in DAS28-CRP (<2.3) at baseline, 6 and 12 months after surgery was 23%, 55% and 53%, respectively. The rate of functional remission in HAQ-DI (<0.5) was 25%, 31% and 30%, respectively. The rate of minimal depression in BDI-II (≤13) was 58%, 64% and 65%, respectively.
Conclusions Favorable effects of orthopedic surgical intervention on QOL and mental wellness as well as physical function were confirmed in the disabled patients with RA. To improve QOL and mental wellness, surgical treatment for the damaged joint should be considered in combination with tight medical control. It also had an ameliorating effect on disease activity.
Ishikawa H, Murasawa A, Nakazono K, et al. The patient-based outcome of upper-extremity surgeries using the DASH questionnaire and the effect of disease activity of the patients with rheumatoid arthritis. Clin Rheumatol 2008;27:967–973.
Disclosure of Interest None declared
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