Risk factors for total knee arthroplasty in rheumatoid arthritis

Abstract

We conducted a study to assess the predictive factors for total knee arthroplasty (TKA) in a cohort of rheumatoid arthritis (RA) patients recruited and followed prospectively for 5 years. A linked registry study using information from a large observational cohort of RA patients followed at the Institute of Rheumatology, Tokyo Women's Medical University (IORRA) was done. Baseline routine clinical and laboratory assessments were recorded. The data were analyzed using the multivariate piecewise-linear Cox (PL-Cox) regression model; the model initially included variables such as gender, age, duration of the disease, visual analog scale (VAS) generated by physicians (VAS-physician), patient-reported VAS for pain (VAS-pain), VAS for general health (VAS-GH), disability level using the Japanese version of the Health Assessment Questionnaire (J-HAQ), C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor (RF), and hemoglobin. Of the 3945 patients registered at baseline, 955 (24.2%) had pain or tenderness in their knee joints, and 114 (11.9%) had TKA surgery in one or both knee joints. On PL-Cox regression, the variables with positive coefficients were J-HAQ, VAS-pain, VAS-physician, and RF positive; advanced age was associated with a reduced risk of TKA. The hazard ratios were: 0.920 for age >60 years; 2.64 for J-HAQ <1.5; 1.01 for J-HAQ >1.5; 1.47 for VAS-pain >6 (cm); 1.20 for VAS-physician >4 (cm); and 2.08 for RF positive. The consistently predictive factors for TKA in RA were age, J-HAQ, VAS-pain, VAS-physician, and RF positive. Age greater than 60 years was associated with a decreased risk of TKA, while J-HAQ from 0 to 1.5, VAS-pain >6 (cm), and VAS-physician >4 (cm) were associated with an increased risk for TKA surgery. These results suggest that, when treating RA patients, physicians should pay particular attention to pain complaints, the patient's daily activity level, and the RF factor status.

Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs

“…Therefore, more postoperative infections were observed in the biologic DMARDs group than in the nonbiologic DMARDs group, suggesting the necessity of attentiveness to joint surgery in RA patients during treatment with TNF blockers, especially in patients with long-established RA. Previously, we reported that the consistently predictive factors for TKA in RA were age, Health Assessment Questionnaire score, visual analog scale (VAS) pain score, VAS-physician score, and rheumatoid factor (RF) positivity [17]. Additionally, resistance to infection may be reduced and susceptibility to infection may be increased in patients with long-established RA due to age, functional disability, and disease activity.…”

“…Among surgical treatments for RA, total hip (THA) and total knee (TKA) arthroplasties are common procedures and are among the most successful surgical interventions for RA to reduce pain and enhance physical function [3,17]. However, prosthetic joint infection can be a very serious problem in RA patients [18], and revision after temporary removal of the prosthesis is sometimes required to alleviate the infection.…”

Thirty-day complications in rheumatoid patients following total knee arthroplasty

“…Primary total knee arthroplasty is the most frequently and successfully performed surgical intervention in RA patients, which greatly enhances their physical function and reduces pain [10]. It is important to evaluate specific demographic characteristics, preoperative comorbidities, social characteristics, perioperative elements, and 30-day postoperative complications that can influence outcomes in RA patients undergoing TKAs.…”

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

“…Orthopedic procedures can substantially improve the overall function and quality of life of RA patients [2]. Among these procedures, 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][5][6][7]. It is generally agreed that TJA is the treatment of choice for relieving pain and improving function.…”