Systemic effects of surgical intervention on disease activity, daily function, and medication in patients with rheumatoid arthritis

Abstract

Objectives: Although tight control of rheumatoid arthritis (RA) has been achieved through the development of effective medication, surgical intervention is still required for a certain subpopulation of patients. To examine the systemic effects of orthopaedic surgery, we evaluated improvements in disease activity, daily function, and medication after surgery.

Method: A prospective cohort study was conducted in 196 cases of elective orthopaedic surgery in 150 patients with RA from January 2011 to March 2014 in our institution. The 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR) and modified Health Assessment Questionnaire (mHAQ) scores just before surgery and at 6 and 12 months after surgery were examined prospectively. Concomitant medications were also investigated.

Results: Significant improvement was seen in the DAS28-ESR and mHAQ scores for replacement surgery in both the upper and lower extremities, and for arthroplasty/arthrodesis in the upper extremities at the 12-month follow-up. Partial mHAQ scores for the lower extremities were significantly reduced in lower replacement surgery, and partial mHAQ scores for the upper extremities were significantly reduced in upper arthroplasty/arthrodesis surgery. Although the use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) did not decrease after surgery, the dose of prednisolone (PSL) decreased significantly at 12 months after surgery, especially in the well-controlled group and in surgical procedures in the lower extremities.

Conclusions: Elective orthopaedic surgery improves both systemic disease activity and general functional impairment. Orthopaedic surgery is effective in reducing the amount of medication required postoperatively.

Acknowledgements

We thank Chikashi Terao and Hiroyuki Yoshitomi, Kyoto University Graduate School of Medicine, for their valuable help, and Wataru Yamamoto, Kurashiki Sweet Hospital, for his help with data management.

Supporting Information

Additional Supporting Information may be found in the online version of this article.

Table S1. Baseline characteristics of the entire cohort.

Table S2. Use of drug therapy at baseline (immediately before surgery), 6 and 12 months after surgery.

Table S3. The classifications and dose of csDMARDs at baseline (immediately before surgery), 6 and 12 months after surgery.

Table S4. Mean score of DAS28-ESR and mHAQ of with and without bMARD.

Table S5. Clinical outcome of bDMARD newly started or switched and no bDMARD.

Figure S1. Mean score of mHAQ on the time of before surgery and at 6 and 12 months postoperatively.

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