Article
Rheumatoid arthritis therapy – influence on results of reconstructive joints operations
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Published: | September 12, 2014 |
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Background: To analyze the results of arthroplasty of the knee and hip joints, depending on the initial activity of the disease and received therapy .
Methods: Total hip and knee prosthesis was used on 48 RA patients (43 women, 5 men ), mean age 49,5 ± 15,8 years. High disease activity by DAS28 was observed in 13 patients (27.1% ), moderate - in 25 ( 52.1 %), the lowest - in 10 ( 20.8 %) patients.
At the time of surgery (before and after) 28 (58.3 % ) patients continued to receive DMARDs . 8 (16.6% ) patients received biologics, which were canceled before the operation in accordance with the terms specified in the national guidelines. 26 (54.1 %) patients received steroids, of which in combination with DMARDs - 9 (18.8% ). Before surgery and in 6 months postoperative period VAS ,DAS28, HAQ have been evaluated.
Results: Within 6 months after surgery VAS decreased at 30,9 ± 18,9 mm ( p < 0.05) , disease activity decreased (high - 5 ( 10.4 % ), moderate 21 (43.75 %) , the lowest -22 (45,8%)), HAQ index decreased from 1,68 ± 0,94 to 1,12 ± 0,73 ( p < 0.05).
VAS pain reduction in patients treated with corticosteroids alone (n = 17 ) was - 24,2 ± 18,2 mm , steroids + DMARD (n = 9 ) - 29,4 ± 18,9 mm, only DMARDs (n = 11) 34,2 ± 19,1 mm, biologics + DMARDs (n = 8 ) 39,1 ± 20,3 mm. DDAS28 did not depend on the received therapy.
Positive dynamics in relation to the functional capacity of patients in the group (n = 19) receiving DMARDs with or without biologics (DHAQ = -0,71 ± 0,32) compared with patients receiving steroids without basic therapy (n = 17 ) - DHAQ = -0,46 ± 0,32 was significantly (p < 0.05) higher.
Conclusion: Total joint replacement is an effective method to improve functional capacity, pain relief and can help to reduce the activity of RA. Functional capacity after surgery is higher in patients receiving DMARDs continuously or receiving biologics compared to patients receiving steroids.