Return of infliximab efficacy after total knee arthroplasty in a patient with rheumatoid arthritis

Toki, Hiroe; Momohara, Shigeki; Ikari, Katsunori; Kawamura, Koichiro; Tsukahara, Sonoko; Mochizuki, Takeshi; Sato, Eri; Yamanaka, Hisashi

doi:10.1007/s10067-008-0858-4

Cited by 10 publications

(5 citation statements)

References 7 publications

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“…Additionally, it is well established that TNF- α , a proinflammatory cytokine is produced by synovial cells and chondrocytes. This led Toki et al to conclude that synovectomy and chondrocyte resection that occurs with TKA help to further improve patient outcome, complementing the action of the DMARDs systemically [13]. However, these medications are associated with an increased risk of opportunistic infections.…”

Section: Perioperative Medication Managementmentioning

confidence: 99%

Total Knee Arthroplasty Considerations in Rheumatoid Arthritis

Danoff

Moss

Liabaud

et al. 2013

Autoimmune Diseases

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The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success.

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Section: Perioperative Medication Managementmentioning

confidence: 99%

Total Knee Arthroplasty Considerations in Rheumatoid Arthritis

Danoff

Moss

Liabaud

et al. 2013

Autoimmune Diseases

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“…It is generally agreed that TJA is the treatment of choice for relieving pain and improving function. However, while excellent clinical results have been reported for TJA in RA patients, there are few studies examining RA disease activity after TJA [8,9]. In clinical practice, we have encountered patients with RA symptoms and laboratory data that dramatically improved following TJA, without any changes having been made in their medical therapy.…”

Section: Introductionmentioning

confidence: 95%

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

et al. 2011

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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.

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“…However, while excellent clinical results have been reported for TKA in RA patients, no studies about RA disease activity after TKA have been reported. We previously encountered an RA patient for whom TKA enabled successful treatment with infliximab after the failure of secondary infliximab therapy [7]. This patient initially experienced a significant decrease in disease activity after treatment with methotrexate (MTX) and infliximab.…”

Section: Introductionmentioning

confidence: 97%

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

et al. 2010

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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.

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Return of infliximab efficacy after total knee arthroplasty in a patient with rheumatoid arthritis

Cited by 10 publications

References 7 publications

Total Knee Arthroplasty Considerations in Rheumatoid Arthritis

Total Knee Arthroplasty Considerations in Rheumatoid Arthritis

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

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

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