Effect of total knee arthroplasty on disease activity in patients with established rheumatoid arthritis: 3-year follow-up results of combined medical therapy and surgical intervention

Abstract

Though excellent clinical results have been reported for total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients, the medium-term effect of TKA on RA disease activity remains unknown. This analysis aimed to assess changes in disease activity after TKA in patients with established RA. We analyzed the systemic effects of TKA on RA disease activity 3 years after intervention. Routine clinical and laboratory assessments were recorded at baseline, less than less than 0.5 years after TKA, and 3 years after TKA. Of the registered RA patients, 130 TKA patients were followed for 3 years after surgery. RA disease activity was measured using the Disease Activity Score 28 (DAS28). Patients were divided into three groups by preoperative baseline DAS28: low (DAS28 ≤ 3.2, n = 8), moderate (DAS28 > 3.2 but ≤5.1, n = 68), and high (DAS28 > 5.1, n = 54) disease activity. The postoperative DAS28 (<0.5 years [DAS1] and 3 years [DAS3] after surgery) scores of each patient were compared to their baseline (DAS0) scores using the paired t-test. The mean DAS28 decreased from 4.85 (DAS0) to 4.14 (DAS1; P = 1.07E-12), and this decrease was sustained at 3 years (DAS3 = 3.97; P = 4.73E-15). Subanalysis results revealed a systemic effect of TKA on disease activity in patients with moderate or high disease activity (DAS0 = 4.33; DAS1 = 3.72 [P = 5.94E-06]; DAS3 = 3.81 [P = 7.89E-06]; and DAS0 = 5.79; DAS1 = 4.86 [P = 1.14E-08]; DAS3 = 4.37 [P = 1.03E-11], respectively). While no significant changes in medication were noted, the average dose of prednisolone tended to decrease over time. We conclude that TKA, which is known to result in good clinical outcomes for damaged knees, has a secondary systemic effect on RA disease activity. Combination therapy consisting of medical treatment and surgical intervention is thought to effectively improve the condition of RA patients who have destructive arthritis in the knee joint, with the effect lasting for at least 3 years.

Recent trends in orthopedic surgery performed in Japan for rheumatoid arthritis

“…TKA was performed on this knee joint, and after this procedure, symptoms and laboratory data dramatically improved when the patient was again treated with infliximab and MTX. Of interest, Yano et al [25] analyzed the systemic effects of TKA on RA disease activity 3 years after surgical intervention. While no significant changes in medications were noted, the average dose of prednisolone and the DAS28 tended to decrease over time.…”

“…While no significant changes in medications were noted, the average dose of prednisolone and the DAS28 tended to decrease over time. It was concluded that TKA, which is known to result in good clinical outcomes for damaged knees, has a secondary systemic effect on RA disease activity for at least 3 years [25].…”

Complex Treatment of Coxarthrosis in Adolescents With Juvenile Rheumatoid Arthritis

“…Несмотря на то, что эндопротезирование крупных суставов при ревматоидном артрите у взрослых пациен-тов является широко применяемым методом оперативно-го лечения [6,7], до сих пор операции на крупных суставах при наличии активного ревматоидного артрита пред-ставляют сложную задачу как для ортопедов-хирургов, так и для ревматологов, осуществляющих дальнейшее ведение этих больных. Тотальное эндопротезирование тазобедренного сустава у подростков является редко используемым методом лечения [8].…”

Does endoprosthetic replacement of large joints improve quality of life in patients with rheumatoid arthritis?

“…Несмотря на то что эндопротезирование крупных су-ставов при РА явилось величайшей вехой в ревмоортопе-дии [8][9][10][11][12][13][14][15], до сих пор операции на крупных суставах при наличии активного РА представляют сложную задачу как для ортопедов-хирургов, так и для ревматологов, осущест-вляющих дальнейшее ведение этих больных.…”

“…Отдаленные резуль-таты оценивались ортопедами-травматологами в основном по общепринятым параметрам в хирургии [11-13, 16, 17], и лишь в отдельных наблюдениях обсуждались показатели КЖ [12,14]. До сих пор остается спорным вопрос об изменении активности РА после эндопротезирования суставов [15].…”