Efficacy of total joint arthroplasty in patients with established rheumatoid arthritis: improved longitudinal effects on disease activity but not on health-related quality of life

Abstract

Though excellent clinical results have been reported for total joint arthroplasty (TJA) in rheumatoid arthritis (RA) patients, the longitudinal effects of TJA on pain, physical function, and health-related quality of life in RA patients remain unknown. This study aimed to assess changes in disease activity and health-related quality of life after TJA in patients with established RA. We analyzed the effect of total knee arthroplasty (TKA) and total hip arthroplasty (THA) on RA disease activity in an observational cohort of RA patients. Of the registered RA patients, 333 TKA and 77 THA patients were followed for 5 years after surgery. RA disease activity and health-related quality of life were measured using the Disease Activity Score 28 (DAS28) and a Japanese version of the Stanford health assessment questionnaire (J-HAQ). The mean DAS28 in TKA patients decreased from 4.66 (preoperatively) to 4.02 (3 years postoperatively) and to 3.94 (5 years postoperatively); the mean DAS28 in THA patients decreased from 4.41 (preoperatively) to 3.99 (3 years postoperatively) and to 3.92 (5 years postoperatively). The mean J-HAQ for TKA remained essentially unchanged, ranging from 1.48 (preoperatively) to 1.45 (3 years postoperatively) and to 1.47 (5 years postoperatively); the mean J-HAQ for THA also remained unchanged, ranging from 1.74 (preoperatively) to 1.74 (3 years postoperatively) and to 1.73 (5 years postoperatively). Of the total J-HAQ score, the lower limb score improved while the upper limb score worsened. Although TKA and THA improve clinical outcomes in damaged knees and hips and have a positive secondary systemic effect on RA disease activity, they have not had a continuously good effect on the measures of health-related quality of life. We conclude that tight control of RA disease activity is indicated for those patients with TKA and/or THA.

Impact of Total Knee Arthroplasty as Assessed Using Patient‐Reported Pain and Health‐Related Quality of Life Indices: Rheumatoid Arthritis Versus Osteoarthritis

“…There was more improvement in the number of joints involved post-TKA among patients with RA versus those with OA, which can again be explained by the greater number of involved joints at baseline in the RA group. Another factor to keep in mind would be that complete removal of the inflamed synovium in RA entails removal of a major source of systemic proinflammatory cytokines, possibly resulting in a decrease in disease activity and inflammation of other joints as well (47). Interestingly, in contrast to the above results, the OA group showed greater improvement in the total joint score, despite having a better total joint score at baseline.…”

“…We can attribute this to the fact that OA usually involves a single joint and removal of that joint leads to a greater improvement in the RADAI score, thus making TKA a "curative" intervention in these patients. In RA patients, in contrast, TKA is merely palliative as it does not significantly improve upper-extremity symptoms that might predominate (3,36,47).…”

“…In the few studies that have addressed patientreported HRQOL in RA patients undergoing TKA, either the number of RA patients was very small or only selected outcome parameters were examined (36,41,43,47). We analyzed multiple patient-reported outcome measures in a large cohort of RA patients and found that beyond pain in the index knee, maximum improvement in patients undergoing TKA was seen in the SF-36 (PCS), HAQ-II, and EQ-5D.…”

Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute

“…Although the number of synovectomies has definitely declined, the numbers of upper limb surgeries and foot arthroplasties have increased. Moreover, when disease activity is increased in joints undergoing damage and destruction in established RA patients, surgical intervention should be considered as a therapeutic option [3]. Together, these studies suggest that RA treatment consisting of both medical treatment and orthopedic joint surgery may lead to a greater improvement in patient quality of life.…”

“…Orthopedic procedures can substantially improve the overall function and quality of life of RA patients. For example, total joint arthroplasty (TJA), such as total knee arthroplasty (TKA) and total hip arthroplasty (THA), has proven to be one of the most successful and most frequently performed orthopedic interventions for reducing pain and enhancing physical function in RA patients [3,4]. It is generally agreed that TJA is the treatment of choice for relieving pain and improving function.…”