Abstract
BackgroundPrevious evidence suggested that perioperative anti-rheumatic therapy for patients receiving total knee arthroplasty (TKA) helped improve postoperative rehabilitation for rheumatoid arthritis (RA), yet long-term effects and outcomes of perioperative drug therapy in TKA presently remain unclear. This study investigated whether perioperative treatment with glucocorticoids (GC) and disease-modifying anti-rheumatic drugs (DMARDs) can improve clinical outcomes for patients with RA undergoing TKA.MethodsPatients between January 2000 and December 2011 were allocated into three groups based on perioperative drug therapy: A, control group (no GC or DMARDs), B, DMARD group (DMARDs given without GC), and C, co-therapy group (DMARDs plus GC). The patients were followed up for average 11.4 years. Baseline characteristics, pre- and post-operative Hospital for Special Surgery score (HSS), laboratory parameters, and complications were recorded by follow-up.ResultsFifty-six RA patients undergoing 91 TKAs were included in this study. Patients who received perioperative GC with DMARDs (group C) achieved larger/increased range of motion (ROM) (C:122.17 vs A:108.31 vs B:108.07, p = 0.001, partial eta squared (η2 p) = 0.18) at 1 year, better HSS score (C, 83.01 vs A, 79.23 vs B, 77.35, p = 0.049, η2 p = 0.067), pain relief (C, 1.09 vs A, 1.17 vs B, 1.75, p = 0.02, η2 p = 0.094), and ROM (C, 130.81 vs A, 112.82 vs B, 113.58, p = 0.001, η2p = 0.142) at latest follow-up comparing with the other treatment groups. No differences were noted in laboratory tests, blood loss, volume of transfusion, or complications among groups.ConclusionsCompared with the other perioperative anti-rheumatic treatments, the combination of GC and DMARDs results in improved HSS score, better function, larger range of motion, and reduced postoperative pain for TKA patients with RA in the long term. Further investigation is warranted to look for a better understanding of more specific medication effects and strike a good balance between the benefits and complications for long-term pharmacotherapy.
Highlights
Rheumatoid arthritis (RA) is often characterized as an inflammatory autoimmune disease, causing cartilage and bone damage with progression to joint malformation and eventual loss of function
Demographic and disease features This study included 91 total knee arthroplasty (TKA) operations performed on 56 rheumatoid arthritis (RA) patients in our hospital, with a mean patient age of 51.7 years
Eight of them (53.3%) accepted treatment with total glucosides of paeony (TGP) or tripterygium glycosides (TG), which is known as antirheumatic drugs extracted from plants
Summary
Rheumatoid arthritis (RA) is often characterized as an inflammatory autoimmune disease, causing cartilage and bone damage with progression to joint malformation and eventual loss of function. For end-stage knee arthropathy of RA patients, total knee arthroplasty (TKA) is an effective approach to achieve outstanding restoration of knee function. It is still an open question how anti-rheumatic medication management should be designed perioperatively. This study intends to evaluate short-term and long-term clinical outcome and postoperative complications associated with preoperative GC and DMARD use in RA patients undergoing TKA surgery. Previous evidence suggested that perioperative anti-rheumatic therapy for patients receiving total knee arthroplasty (TKA) helped improve postoperative rehabilitation for rheumatoid arthritis (RA), yet long-term effects and outcomes of perioperative drug therapy in TKA presently remain unclear. This study investigated whether perioperative treatment with glucocorticoids (GC) and disease-modifying anti-rheumatic drugs (DMARDs) can improve clinical outcomes for patients with RA undergoing TKA
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