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AB0438 Rheumatoid arthritis drug therapy in the perioperative period of large joints arthroplasty, its impact on the long-term results of surgery
  1. S Lapshina1,
  2. I Akhtyamov1,2,
  3. I Gilmutdinov2,
  4. L Myasoutova1
  1. 1Kazan State Medical University
  2. 2Republic Clinical Hospital, Kazan, Russian Federation

Abstract

Objectives To analyze the results of large joints arthroplasty depending on the received rheumatoid arthritis (RA) drug therapy

Methods Knee and hip joints arthroplasty was performed for 54 RA patients (48 women, 6 men), mean age 51,4±12,8 years. At the time of the operation disease duration was 11,8±3,8 years, high activity (DAS28) - in 26%, moderate - in 55.5%, the low - at 18.5% patients. At the time of surgery 39 (72.2%) pts continued to take basic anti-rheumatic drugs (DMARDs) (methotrexate at a dose of 10–20 mg per week - 32, leflunomide (20 mg daily) -5). Corticosteroids (prednisone at a dose of 5–15 mg, an average of 7.1 mg per day) - 25 (46.2%) patients, of which in combination with DMARDs - 10 (18.6%). Before the operation, and after the 6 months joint pain (VAS), disease activity - DAS28, functional ability HAQ index were evaluated. In 32 patients, these same indexes were estimated after 12 months.

Results The reduction of pain intensity VAS was observed in the first month after a joint arthroplasty, after 6 months VAS fell almost to 31.8 mm (p<0.05). Activity of the disease decreased (high - 11.2%, moderate - 44.4%, low - 44.4%), HAQ - from 1,61±0,41 to 1,09±0,26 (p<0, 05). After 12 months HAQ - 1,01±0,28.

The analysis showed that in patients not receiving corticosteroids (n=29) arthroplasty was conducted in 13,6±3,2 years after RA onset, and receiving long-term steroids (n=25) significantly earlier (p<0,05) - through 9,9±3,5 years. The functional capacity of patients in the group receiving DMARDs without corticosteroids (n=29) (the HAQ 6 months - 0,9±0,24, 12 months - 0 81±0,16) was significantly (p<0.05) higher compared with patients receiving corticosteroids (n=25) without the basic treatment (HAQ 6 months -1.13±0.21, over 12 months- 1,24±0,19)

Conclusions Large joints arthroplasty is an effective method to improve the functional capacity of patients with RA. For patients receiving corticosteroids need of arthroplasty arises a few years earlier. The function of the joints after surgery and in the remote period is better when patients continuously receive DMARDs compared to steroid therapy, the dose should be reduced to a reasonable minimum for the time of surgical treatment.

Disclosure of Interest None declared

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