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.

Long‐term patient reported outcomes of elbow, wrist and hand surgery for rheumatoid arthritis

“…Thus, there seems to be a relationship between the intensity of inflammation and the patient's satisfaction with a pain‐free condition at the site of surgery. Some previous reports demonstrated that surgical intervention, especially synovectomy and arthroplasty, enhances the amelioration of systemic disease activity as well as joint function . In this study, the elbow, wrist and hand surgeries might have enhanced the amelioration of the disease activity to some extent.…”

Effect of total knee arthroplasty on other joints in patients with rheumatoid arthritis evaluated by 18-FDG-PET

“…Total arthroplasty is also expected to restore ADL. Momohara et al . reported that although DAS28 had improved 5 years after TKA or total hip arthroplasty (THA), Japanese‐HAQ(J‐HAQ) remained unchanged.…”

“…At baseline (just before TKA) and 12 weeks after TKA, CRP, ESR and matrix metalloproteinase‐3 (MMP‐3) were measured as inflammation and cartilage markers. The Disease Activity Score of 28 joints (DAS28)‐ESR and DAS28‐CRP, clinical disease activity index (CDAI) and simplified disease activity index (SDAI) were used to evaluate RA disease activity. TJC and SJC for the above‐mentioned 28 joints, PVAS and EVAS were also assessed.…”

“…There have been a few reports that surgery may improve disease activity in RA patients . However, the RA disease activity index consists of components comprising the inflammatory markers C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR), tender joint count (TJC), swollen joint count (SJC), patient global visual analogue scale (PVAS) assessment and evaluator global visual analogue scale (EVAS) assessment .…”

Hip score and disease activity correlation in patients with rheumatoid arthritis after total hip arthroplasty

“…THA and TKA may possibly have additional effects on RA disease activity. Previously, it was reported that disease activity after THA and TKA, as evaluated by the DAS28, had decreased in patients with RA [19]. Inflamed knee joints greatly affect RA disease activity, and are readily identified because the knee joint is included in the DAS28, SDAI and CDAI assessments.…”