gms | German Medical Science

Objectives/Interrogation: With the advent of biological therapy, an early diagnosis and early treatment with tight control have become increasingly important for the treatment of rheumatoid arthritis (RA). Many patients with RA can live a normal life without joint deformity. With the more widespread use of various biological agents, the number of large joint surgeries has decreased, while the number of small joints has increased in our center hospital of rheumatic diseases. The objectives of this study is to investigate the long-term outcome of the rheumatoid wrist surgery without prosthesis.

Methods: We investigated the results of ten years after wrist surgeries without prosthesis in our hospital. All procedures were performed from November 2006 to December 2008. There were 84 wrists in 80 patients (male, n=15; female, n=65). The average age at operation were 61 years, the average duration of RA were 11 years. The operative procedures were as follows: limited arthrodesis (59 wrists), Sauvé-Kapandji's operation (7 wrists), Clayton's tendon transfer (16 wrists), and arthroplasty at the midcarpal joint using the palmaris longus (PL) tendon ball (18 wrists).

Ten years later, we obtained data from 48 wrists in 46 cases. We assessed the DASH score, grip power (GP), range of motion (ROM) and carried out a questionnaire survey. The questionnaire investigated the perioperative memory, current state and satisfaction with the operation.

Results and Conclusions: The mean age was 66 years, the mean duration between the onset of RA to the operation was 9.5 years, the mean DAS28-ESR(4) was 2.63, the mean of CRP level was 0.32mg/dL. The MTX medication ratio and its mean dose was 33/48 (67%), 8.3 mg/week. The PSL medication ratio and its mean dose was 26/48 (54.2%), 3.4 mg/day. Twenty-two patients were using biological agents. The average arc for extension/flexion had worsened (56.5±28.9 to 32.0±27.8), while the average arc for supination/pronation had improved (145.8±28.6 to 148.6±23.5). The average GP (139.0±67.8mmHg to 175.3±68.1 mmHg) and average DASH score (34.8±17.8 to 28.3±24.1) both showed improvement. The results of questionnaire showed that most patients were satisfied with their wrists at 10 years after the operation. Patients who were highly satisfied with the operation had a shorter disease duration and shorter interval between the onset of disease and their operation.

A long-term favorable outcome of rheumatoid wrist surgery without prosthesis is expected under the good medical control of the disease.