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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

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Modern Rheumatology

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.

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References

  1. Seki E, Matsushita I, Sugiyama E, Taki H, Shinoda K, Hounoki H, et al. Radiographic progression in weight-bearing joints of patients with rheumatoid arthritis after TNF-blocking therapies. Clin Rheumatol. 2009;28(4):453–60.

    Article  PubMed  Google Scholar 

  2. Anderson RJ. The orthopedic management of rheumatoid arthritis. Arthritis Care Res. 1996;9(3):223–8.

    Article  PubMed  CAS  Google Scholar 

  3. da Silva E, Doran MF, Crowson CS, O’Fallon WM, Matteson EL. Declining use of orthopedic surgery in patients with rheumatoid arthritis? Results of a long-term, population-based assessment. Arthritis Rheum. 2003;49(2):216–20.

    Article  PubMed  Google Scholar 

  4. Trieb K, Schmid M, Stulnig T, Huber W, Wanivenhaus A. Long-term outcome of total knee replacement in patients with rheumatoid arthritis. Joint Bone Spine. 2008;75(2):163–6.

    Article  PubMed  Google Scholar 

  5. Jones DL, Westby MD, Greidanus N, Johanson NA, Krebs DE, Robbins L, et al. Update on hip and knee arthroplasty: current state of evidence. Arthritis Rheum. 2005;53(5):772–80.

    Article  PubMed  Google Scholar 

  6. Momohara S, Inoue E, Ikari K, Kawamura K, Tsukahara S, Mochizuki T, et al. Risk factors for total knee arthroplasty in rheumatoid arthritis. Mod Rheumatol. 2007;17(6):476–80.

    Article  PubMed  CAS  Google Scholar 

  7. Yoshino K, Momohara S, Ikari K, Kawamura K, Mochizuki T, Iwamoto T, et al. Acute destruction of the hip joints and rapid resorption of femoral head in patients with rheumatoid arthritis. Mod Rheumatol. 2006;16(6):395–400.

    Article  PubMed  Google Scholar 

  8. Toki H, Momohara S, Ikari K, Kawamura K, Tsukahara S, Mochizuki T, et al. Return of infliximab efficacy after total knee arthroplasty in a patient with rheumatoid arthritis. Clin Rheumatol. 2008;27(4):549–50.

    Article  PubMed  Google Scholar 

  9. Yano K, Ikari K, Inoue E, Tokita A, Sakuma Y, Hiroshima R, et al. 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. Mod Rheumatol. 2010;20(5):452–7.

    Article  PubMed  Google Scholar 

  10. Yamanaka H, Inoue E, Singh G, Tanaka E, Nakajima A, Taniguchi A, et al. Improvement of disease activity of rheumatoid arthritis patients from 2000 to 2006 in a large observational cohort study IORRA in Japan. Mod Rheumatol. 2007;17(4):283–9.

    Article  PubMed  Google Scholar 

  11. Tanaka E, Mannalithara A, Inoue E, Hara M, Tomatsu T, Kamatani N, et al. Efficient management of rheumatoid arthritis significantly reduces long-term functional disability. Ann Rheum Dis. 2008;67(8):1153–8.

    Article  PubMed  CAS  Google Scholar 

  12. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315–24.

    Article  PubMed  CAS  Google Scholar 

  13. Matsuda Y, Singh G, Yamanaka H, Tanaka E, Urano W, Taniguchi A, et al. Validation of a Japanese version of the Stanford Health Assessment Questionnaire in 3,763 patients with rheumatoid arthritis. Arthritis Rheum. 2003;49(6):784–8.

    Article  PubMed  Google Scholar 

  14. Wolfe F, Zwillich SH. The long-term outcomes of rheumatoid arthritis: a 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis. Arthritis Rheum. 1998;41(6):1072–82.

    Article  PubMed  CAS  Google Scholar 

  15. Nakamura H, Tanaka H, Yoshino S. Long-term results of multiple synovectomy for patients with refractory rheumatoid arthritis. Effects on disease activity and radiological progression. Clin Exp Rheumatol. 2004;22(2):151–7.

    PubMed  CAS  Google Scholar 

  16. Ward MM. Decreases in rates of hospitalizations for manifestations of severe rheumatoid arthritis, 1983–2001. Arthritis Rheum. 2004;50(4):1122–31.

    Article  PubMed  Google Scholar 

  17. Weiss RJ, Ehlin A, Montgomery SM, Wick MC, Stark A, Wretenberg P. Decrease of RA-related orthopaedic surgery of the upper limbs between 1998 and 2004: data from 54,579 Swedish RA inpatients. Rheumatology (Oxford). 2008;47(4):491–4.

    Article  CAS  Google Scholar 

  18. Momohara S, Inoue E, Ikari K, Kawamura K, Tsukahara S, Iwamoto T, et al. Decrease in orthopaedic operations, including total joint replacements, in patients with rheumatoid arthritis between 2001 and 2007: data from Japanese outpatients in a single institute-based large observational cohort (IORRA). Ann Rheum Dis. 2010;69(1):312–3.

    Article  PubMed  CAS  Google Scholar 

  19. Momohara S, Ikari K, Mochizuki T, Kawamura K, Tsukahara S, Toki H, et al. Declining use of synovectomy surgery for patients with rheumatoid arthritis in Japan. Ann Rheum Dis. 2009;68(2):291–2.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank all participating rheumatologists and orthopedic surgeons, as well as the staff of the IORRA cohort study group. This study was funded through a research grant from 36 pharmaceutical companies given for the support of the large observational cohort study of RA at the Institute of Rheumatology, Tokyo Women’s Medical University.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University, 10-22 Kawada, Shinjuku, Tokyo, 162-0054, Japan

    Shigeki Momohara, Eisuke Inoue, Katsunori Ikari, Koichiro Yano, Asami Tokita, Taku Suzuki, Yu Sakuma, Ryo Hiroshima, Kosei Kawakami, Ikuko Masuda, Takuji Iwamoto, Atsuo Taniguchi & Hisashi Yamanaka

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  1. Shigeki Momohara
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  2. Eisuke Inoue
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  3. Katsunori Ikari
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  4. Koichiro Yano
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  5. Asami Tokita
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  6. Taku Suzuki
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  7. Yu Sakuma
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  8. Ryo Hiroshima
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  9. Kosei Kawakami
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  10. Ikuko Masuda
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  11. Takuji Iwamoto
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  12. Atsuo Taniguchi
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  13. Hisashi Yamanaka
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Correspondence to Shigeki Momohara.

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Momohara, S., Inoue, E., Ikari, K. et al. 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. Mod Rheumatol 21, 476–481 (2011). https://doi.org/10.1007/s10165-011-0432-9

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  • DOI: https://doi.org/10.1007/s10165-011-0432-9

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