TY - JOUR
T1 - Efficacy of total joint arthroplasty in patients with established rheumatoid arthritis
T2 - Improved longitudinal effects on disease activity but not on health-related quality of life
AU - Momohara, Shigeki
AU - Inoue, Eisuke
AU - Ikari, Katsunori
AU - Yano, Koichiro
AU - Tokita, Asami
AU - Suzuki, Taku
AU - Sakuma, Yu
AU - Hiroshima, Ryo
AU - Kawakami, Kosei
AU - Masuda, Ikuko
AU - Iwamoto, Takuji
AU - Taniguchi, Atsuo
AU - Yamanaka, Hisashi
N1 - Funding Information:
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.
PY - 2011/10
Y1 - 2011/10
N2 - 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.
AB - 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.
KW - Disease Activity Score (DAS)
KW - Health assessment questionnaire (HAQ)
KW - Rheumatoid arthritis
KW - Total hip arthroplasty (THA)
KW - Total knee arthroplasty (TKA)
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U2 - 10.1007/s10165-011-0432-9
DO - 10.1007/s10165-011-0432-9
M3 - Article
C2 - 21373798
AN - SCOPUS:84855707874
SN - 1439-7595
VL - 21
SP - 476
EP - 481
JO - Japanese Journal of Rheumatology
JF - Japanese Journal of Rheumatology
IS - 5
ER -