Effect of rheumatoid arthritis drug therapy on results of large joint arthroplasty (preliminary report)

Cover Page


Cite item

Abstract

Purpose: to evaluate the results of the knee and hip arthroplasty in patients with rheumatoid arthritis (RA) depending on baseline disease activity and received drug therapy. Materials and methods. Arthroplasty was performed in 48 patients (hip - 39 and knee - 9) with RA. The mean age was 49.5±15.82 years. Disease activity according to DAS28 - 4.41±1.83. All the patients received NSAIDs in stable doses. 26 (54.2%) patients received corticosteroids at a dose of 5-10 mg/day in terms of prednisolone, and 30 (62.5%) -basic antirheumatic drugs (DMARDs). Treatment was ongoing at the time of surgery and 6 months or more after it. Assessment of pain (VAS), disease activity (DAS28), quality of life (HAQ) were evaluated preoperatively, before discharge from hospital and 6 months after. Results. The pain (VAS) decreased by 34.2±19.1 mm in patients who received DMARDs and HAQ by 0.70±0.32 (p<0.05) compared with patients treated with corticosteroids without basic therapy (AVAS 24.2±18.2 mm, AHAQ = 0.46±0.31). Postoperative complications such as deep vein thrombosis and soft tissue infections are more likely in patients receiving steroid therapy. Conclusion. Arthroplasty is an effective method in improving the functional status, pain relief and it helps to reduce the rheumatoid arthritis activity. Surgery results in relation to the life were better in patients taking DMARDs. Steroids undoubtedly increase the risk of complications and decrease effectiveness of arthroplasty. It was recommended to reduce steroids dose during preparation of patient for surgery.

About the authors

I. F. Akhtyamov

Kazan State Medical University; Republican Clinical Hospital

Author for correspondence.
Email: yalta60@mail.ru
Russian Federation

S. A. Lapshina

Kazan State Medical University; Republican Clinical Hospital

Email: noemail@neicon.ru
Russian Federation

I. S. Gilmutdinov

Republican Clinical Hospital

Email: noemail@neicon.ru
Russian Federation

L. I. Myasoutova

Kazan State Medical University

Email: noemail@neicon.ru
Russian Federation

References

  1. Белов Б.С. Бактериальный (септический) артрит и инфекция протезированного сустава: современные аспекты. Современная ревматология. 2010; (3):10-17.
  2. Галушко Е.А., Эрдес Ш.Ф., Амирджанова В.Н. Особенности диагностики ревматоидного артрита в реальной клинической практике. Научно-практическая ревматология. 2011; (1):21-27.
  3. Макаров С.А., Павлов В.П. Актуальные проблемы эндопротезирования тазобедренного сустава при ревматических заболеваниях (по данным зарубежной литературы за 2006-2011 гг.). Научно-практическая ревматология. 2012; 51(2):112-114.
  4. Погожева Е.Ю., Амирджанова В.Н., Макаров С.А., Насонов Е.Л. Осложнения после эндопротезирования суставов упациентов, получающих генно-инженерные биологические препараты. Научно-практическая ревматология. 2012; 52(3):43-48.
  5. Ревматология: клинические рекомендации. Под ред. Е.Л. Насонова. М.: ГЭОТАР-Медиа; 2010. 752 с.
  6. Савенкова Н.А., Амирджанова В.Н., Макаров С.А. и др. Улучшает ли эндопротезирование крупных суставов качество жизни больных ревматоидным артритом? Научно-практическая ревматология. 2011; (1):69-74.
  7. Савенкова Н.А., Амирджанова В.Н., Макаров С.А. и др. Отменять ли базисную терапию больным ревматоидным артритом перед эндопротезированием суставов? Научно-практическая ревматология. 2011; (3):46-50.
  8. Рекомендации по лечению ревматоидного артрита. Е.Л. Насонов, Д.Е. Каратеев по поручению группы экспертов АРР, 2013 г. http://rheumatolog.ru/experts/ klinicheskie-rekomendacii.
  9. Bongartz T. Elective orthopedic surgery and perioperative DMARD management: many questions, fewer answers, and some opinions.. J Rheumatol. 2007; 34:653-655.
  10. Felson D.T., Anderson J.J., Boers M., Bombardier C., Chernoff M., Fried B. et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum. 1993;36(6):729-740.
  11. Smolen J.S., Aletaha D., Bijlsma J.W. et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010; 69(4): 631-637.

Copyright (c) 2015



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies