Rheumatoid Patients Research Articles

A Study of Postoperative Follow-up and Quality of Life after Total Condylar Type Total Knee Arthroplasty in Rheumatoid Patients

A Study of Postoperative Follow-up and Quality of Life after Total Condylar Type Total Knee Arthroplasty in Rheumatoid Patients

Spontaneous Rupture of the Extensor Tendon of the Hand in Rheumatoid Patients

Spontaneous Rupture of the Extensor Tendon of the Hand in Rheumatoid Patients

Studies on the Rapid Destruction of Hip Joints in Rheumatoid Patients

Studies on the Rapid Destruction of Hip Joints in Rheumatoid Patients

Roentgenological Analysis of the Forefoot Deformity in Rheumatoid Patients with special Reference to Hallux Valgus

Roentgenological Analysis of the Forefoot Deformity in Rheumatoid Patients with special Reference to Hallux Valgus

Clinical Experience with the Total Condylar Type Knee System in Rheumatoid and Osteoarthritic Patients

Clinical Experience with the Total Condylar Type Knee System in Rheumatoid and Osteoarthritic Patients

Long-term Follow-up Study of Total Hip Replacement for Rheumatoid Patients

Long-term Follow-up Study of Total Hip Replacement for Rheumatoid Patients

Total Knee Replacement in Non-ambulatory Rheumatoid Patients with Severely Destructed Knee Joint

Total Knee Replacement in Non-ambulatory Rheumatoid Patients with Severely Destructed Knee Joint

The Physical Fitness of Rheumatoid Patients

The Physical Fitness of Rheumatoid Patients

The Problems of Multiple Joint Replacement in the Lower Extremities of Rheumatoid Patients

The Problems of Multiple Joint Replacement in the Lower Extremities of Rheumatoid Patients

Loosening and Radiolucent Zones around the Femoral Component after Cementless Total Knee Arthroplasty for Rheumatoid Patients

Loosening and Radiolucent Zones around the Femoral Component after Cementless Total Knee Arthroplasty for Rheumatoid Patients

The Kudo 5 total elbow replacement in the treatment of the rheumatoid elbow

Between September 1993 and September 1996, we performed 34 Kudo 5 total elbow replacements in 31 rheumatoid patients. All 22 surviving patients were reviewed at a mean of 11.9 years (10 to 14). Their mean age was 56 years (37 to 78) at the time of operation. All had Larsen grade IV or V rheumatoid changes on X-ray. Nine (three bilateral replacements and six unilateral) had died from unrelated causes. One who had died before ten years underwent revision for dislocation. Of the 22 total elbow replacements reviewed six had required revision, four for aseptic loosening (one humeral and three ulnar) and two for infection. Post-operatively, one patient had neuropraxia of the ulnar nerve and one of the radial nerve. Two patients had valgus tilting of the ulnar component. With revision as the endpoint, the mean survival time for the prosthesis was 11.3 years (95% confidence interval (10 to 13) and the estimated survival of the prosthesis at 12 years according to Kaplan-Meier survival analysis was 74% (95% confidence interval 0.53 to 0.91). Of the 16 surviving implants, ten were free from pain, four had mild pain and two moderate. The mean arc of flexion/extension of the elbow was 106° (65° to 130°) with pronation/supination of 90° (30° to 150°) with the joint at 90° of flexion. The mean Mayo elbow performance score was 82 (60 to 100) with five excellent, ten good and one fair result. Good long-term results can be expected using the Kudo 5 total elbow replacement in patients with rheumatoid disease, with a low incidence of loosening of the components.

Cemented Glenohumeral Fixation: Standard of Care—Affirms

Cemented humeral stem fixation in shoulder joint arthroplasty has been, and continues to be the “gold standard” to ensure satisfactory implant orientation and stability. The most commonly performed type of shoulder arthroplasty is hemi-arthroplasty in the face of comminuted fracture. Appropriate stem height and version relative to the glenoid is paramount in obtaining a satisfactory result. This has been proven to be reliably reproducible through cement fixation of the stem with careful reattachment of the tuberosities. Total shoulder arthroplasty in rheumatoid patients with questionable bone stock likewise has relied upon “cementation” of the humeral component to ensure secure fixation, prevent loosening and avoid subsidence. In younger patients it is tempting to want to avoid cement in the proximal humerus, nonetheless most studies have demonstrated loosening of the humeral component not to be problematic once cement has been used. In addition, newer modular componentry allows head removal (without stem removal) providing ready access to the glenoid should glenoid revision be needed. The ability to add antibiotics within the cement mantle in high-risk patients additionally affords an advantage in treating and/or avoiding infection. Survivorship studies have not demonstrated any advantage of cementless versus cement fixation of the humeral component in shoulder arthroplasty. Temporizing techniques such as cup arthroplasty and hybrid techniques such as placing tantalum weave surfaces proximally for enhanced tuberosity fixation may have a role, but do not replace the long-standing efficacy of cement fixation of the humeral component in the vast majority of patients requiring shoulder arthroplasty.

Can the application of control theory assist patient management in rheumatoid arthritis?

Supporting patient self-management is an important part of the care of patients with rheumatoid arthritis (RA) but patients vary in their capacity and willingness to manage their illness and may feel overwhelmed by the challenge of controlling the impact on their life. This paper discusses the value and importance of control theory and how it might be applied to enhance patients' self-management. Not only does it offer a means of identifying those who might have greatest difficulty in managing their illness, but it also points the way to effective interventions.

Effects of Extensor Synovectomy and Excision of the Distal Ulna in Rheumatoid Arthritis on Long-Term Function

Objective outcomes data after excision of the distal ulna in rheumatoid arthritis are lacking. The aim of this study was to evaluate the functional results of this surgery in the long term. We prospectively collected data on range of motion (22 wrists), visual analog pain scores (14 wrists), and grip strength measured using a Jamar dynamometer (20 hands) in a group of 23 patients (26 wrists) preoperatively and at 3 months, 12 months, and a minimum of 5 years postoperatively (range, 5.3-10.4 y). The Jebsen-Taylor hand function test was administered to 9 patients at the same time points. A subgroup of patients also underwent extensor carpi radialis longus to extensor carpi ulnaris tendon transfer (11 wrists). At one year, there were improvements in wrist pronation and supination, which were maintained at final follow-up. Active radial deviation decreased significantly at 3 months (p = .01) and one year (p = .02); this remained reduced at final follow-up (not significant). Wrist extension and active ulnar deviation showed slight improvements by one year, but reduced to levels below that measured preoperatively by final follow-up. Wrist flexion was significantly reduced at all time points postoperatively. Grip strength showed improvement from 10.0 kg (standard deviation [SD] 4.1 kg) preoperatively to 12.5 kg (SD 4.6 kg) 1 year after surgery and returned to preoperative levels (9.5 kg, SD 5.6 kg) by final follow-up. Wrist pain was significantly reduced from a mean score of 5 (SD 4) preoperatively to 2 (SD 2) postoperatively (p = .01). The Jebsen-Taylor hand function test showed improvements in writing and card turning. In the long term, excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function. There is a significant (p = .01) reduction in wrist pain but a reduction of wrist flexion. Therapeutic IV.

Prognostic Factors in Arthroplasty in the Rheumatoid Shoulder

Total shoulder arthroplasty is commonly considered a good option for treatment of the rheumatoid shoulder. However, when the rotator cuff and glenoid bone stock are not preserved, the clinical outcome of arthroplasty in the rheumatoid patients remains unclear. Aim of the study is to explore the prognostic value of multiple preoperative and peroperative variables in total shoulder arthroplasty and shoulder hemiarthroplasty in rheumatoid patients. Clinical Hospital for Special Surgery Shoulder score was determined at different time points over a mean period of 6.5 years in 66 rheumatoid patients with total shoulder arthroplasty and 75 rheumatoid patients with shoulder hemiarthroplasty. Moreover, radiographic analysis was performed to assess the progression of humeral head migration and glenoid loosening. Advanced age and erosions or cysts at the AC joint at time of surgery were associated with a lower postoperative Clinical Hospital for Special Surgery Shoulder score. In total shoulder arthroplasty, status of the rotator cuff and its repair at surgery were predictive of postoperative improvement. Progression of proximal migration during the period after surgery was associated with a lower clinical score over time. However, in hemiarthroplasty, no relation was observed between the progression of proximal or medial migration during follow-up and the clinical score over time. Status of the AC joint and age at the time of surgery should be taken into account when considering shoulder arthroplasty in rheumatoid patients. Total shoulder arthroplasty in combination with good cuff repair yields comparable clinical results as total shoulder arthroplasty when the cuff is intact.

The effect of desmopressin on blood loss in patients with rheumatoid arthritis undergoing hip arthroplasty

Blood loss is an important issue for patients with rheumatoid arthritis undergoing hip surgery. We hypothesised that intraoperative desmopressin treatment would result in a reduction in blood loss in rheumatoid patients undergoing total hip arthroplasty. Seventy-five patients scheduled for elective total hip arthroplasty were randomised to three groups to receive 0.4 microg/kg desmopressin (D 0.4), 0.2 microg/kg desmopressin (D 0.2) or placebo intraoperatively in a double-blind fashion. Blood transfusions were based on calculated safe allowable blood loss and haemoglobin measurements (trigger 90 g/l, 5.59 mmol/l). The primary endpoint was the total blood loss measured till the end of the fourth post-operative day. Secondary endpoints included red cell transfusion requirements and haemoglobin. Total blood loss during the study period was not significantly different between the groups (D 0.4 1829 +/- 1068; D 0.2 2240 +/- 843 and placebo 2254 +/- 1040 ml; P= 0.50). The total amount of red cell transfusions was fewer in group D 0.4 (3.6 +/- 1.6 U) when compared with D 0.2 (4.4 +/- 1.7 U; P=0.009) and placebo (4.5 +/- 2.0 U; P= 0.011) groups. Haemoglobin concentration was lower in the placebo group in the first (5.42 +/- 1.16 vs. 5.98 +/- 0.47 mmol/l; P=0.033) and the second (6.28 +/- 0.66 vs. 6.69 +/- 0.47 mmol/l; P=0.033) post-operative mornings compared with group D 0.4. Despite a lack of difference in the primary outcome, total blood loss, intraoperative administration of 0.4 microg/kg desmopressin resulted in fewer total red cell transfusion requirements in rheumatoid patients undergoing total hip arthroplasty when compared with 0.2 microg/kg treatment and placebo.

Can Cyclosporine-A Associated to Methotrexate Maintain Remission Induced by Anti-TNF Agents in Rheumatoid Arthritis Patients? (Cynar Pilot Study)

Biological therapies, such as etanercept, adalimumab and infliximab, have demonstrated good efficacy in inducing rheumatoid arthritis to low disease activity levels. Nevertheless, their cost, as well as the related risk of side effects, especially in long-term therapies, are still high. Furthermore, there is a good deal of evidence proving loss of efficacy of such therapies in the long term, often necessitating the shift from one specific anti-TNF biological treatment to another. There are also other open debates on the amount of time a patient should undergo an anti-TNF therapy, on the possibility of inducing a complete remission in early arthritis and, once remission or low disease activity is obtained, on the possibility of interrupting the anti-TNF-based therapy. In this study we investigated whether A-Cyclosporin and Methotrexate association may be effective in maintaining low disease activity obtained by anti-TNF therapies. Twenty-three rheumatoid arthritis-affected patients, whose diagnosis was made according to ACR criteria, with a disease duration of less than 3 years, and DAS28<3.2 that reached a level of low disease activity within 6-8 months from beginning anti-TNF and Methotrexate therapy, were enrolled in the study. After the suspension of anti-TNF therapy, patients were started on A-Cyclosporine (2-3 mg/kg/day) and Methotrexate (15mg/week) therapy. DAS28, Pain VAS, Erythrosedimentation Rate (ESR), and C Reactive Protein (CRP) were all tested at time 0 and at 6 months, as well as liver and kidney profiles, after the interruption of the anti-TNF therapy and the beginning of A-Cyclosporine and Methotrexate therapy. Side effects were also recorded. Of 23 patients undergoing the A-Cyclosporin and Methotrexate therapy for maintaining low disease activity in rheumatoid arthritis obtained by 6-8 months of anti-TNF therapy, 21 completed the study with a 6 month follow-up. Thirteen patients maintained clinical parameters within low disease activity values, while 8 patients showed an increase in DAS28 and other parameters. Only two patients showed an increase in blood pressure that was diagnosed after two months from the beginning of the A-Cyclosporin and Methotrexate therapy. The reduction in the dosage of A-Cyclosporin from 3mg/kg/day to 2mg/kg/day caused a slow normalization of blood pressure values. Our data seem to suggest that more than half of the patients undergoing A-Cyclosporin and Methotrexate therapy seemed to maintain low disease activity parameters of rheumatoid arthritis, obtained after 6-8 months of anti-TNF therapy. Further studies on larger populations are necessary in order to confirm such results and identify predictor factors for different responses.

Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years

Most long-term followup studies of younger patients who underwent TKA include a relatively high percentage of rheumatoid patients, whose function and implant durability may differ from those with osteoarthritis (OA). The purpose of this study was to evaluate the minimum 10 year followup of TKA performed in more active patients with OA, using modular tibial components, to determine the durability of that construct. Specifically, we determined (1) survivorship; (2) revision rates; (3) functional scores; and (4) rates of radiographic failure at a minimum 10 year followup. We retrospectively reviewed 59 patients (67 knees) with OA who underwent primary total knee arthroplasty with posterior cruciate retaining (27%) or posterior cruciate substituting (73%) components which had modular tibial trays. Patients were evaluated clinically for need of revision and Knee Society, SF-36 and WOMAC scores as well as UCLA and Tegner activity scores. Radiographs were evaluated for loosening and osteolysis. The minimum followup of living patients was 10 years (mean, 12.4 years; range, 10 to 18.4 years). Ten patients (11 knees) died; two patients (2 knees) were lost to followup. Ten patients (11 knees; 16%) had revisions for aseptic loosening and/or osteolysis. Thirty-one patients (65%) were still performing moderate labor or sports activities. The average UCLA score was 5.5 (range, 2-9). No nonrevised knee demonstrated radiographic loosening. Most patients in this active patient population continued to have acceptable function although 16% underwent revision for wear and/or osteolysis. Isolated tibial insert exchange alone was performed in four of the 11 (36%) revised knees. These data should provide comparison for total knee arthroplasties performed in younger patients with newer designs and newer bearing materials. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Simplified approach to MR image quantification of the rheumatoid wrist: a pilot study

To determine an optimal threshold in a simplified 3D-based volumetry of abnormal signals in rheumatoid wrists utilizing contrast and non-contrast MR data, and investigate the feasibility and reliability of this method. MR images of bilateral hands of 15 active rheumatoid patients were assessed before and 5 months after the initiation of tocilizumab infusion protocol. The volumes of abnormal signals were measured on STIR and post-contrast fat-suppressed T1-weighted images. Three-dimensional volume rendering of the images was used for segmentation of the wrist by an MR technologist and a radiologist. Volumetric data were obtained with variable thresholding (1, 1.25, 1.5, 1.75, and 2 times the muscle signal), and were compared to clinical data and semiquantitative MR scoring (RAMRIS) of the wrist. Intra- and interobserver variability and time needed for volumetry measurements were assessed. The volumetric data correlated favorably with clinical parameters almost throughout the pre-determined thresholds. Interval differences in volumetric data correlated favorably with those of RAMRIS when the threshold was set at more than 1.5 times the muscle signal. The repeatability index was lower than the average of the interval differences in volumetric data when the threshold was set at 1.5-1.75 for STIR data. Intra- and interobserver variability for volumetry was 0.79-0.84. The time required for volumetry was shorter than that for RAMRIS. These results suggest that a simplified MR volumetric data acquisition may provide gross estimates of disease activity when the threshold is set properly. Such estimation can be achieved quickly by non-imaging specialists and without contrast administration.

Mid-term results of joint-preserving procedures by a modified Mann method for big toe deformities in rheumatoid patients undergoing forefoot surgeries

This study aimed to evaluate joint-preserving procedures by a modified Mann method for rheumatoid forefoot deformities and their functional outcomes in the mid-term. Eleven feet in seven patients underwent forefoot surgery using a modified Mann method for the big toe, combined with offset osteotomy or resection arthroplasty of the lesser toes. The mean follow-up period was 3.6 years. The mean score on the Japanese Society for Surgery of the Foot scale for rheumatoid arthritis foot and ankle joints improved from 44.0 to 72.0. The mean hallux valgus angle improved from 39.4° to 20.5° and the mean M1M5 angle improved from 31.1° to 25.8°. However, deformities involving a hallux valgus angle of more than 25.0° recurred in three feet at the latest follow-up, although the patients did not complain of any symptoms from the recurrence. Improvement in the Sharp score for joint space narrowing was observed in the big toe, indicating better congruity of the metatarsophalangeal joint. For restraint of rheumatoid forefoot deformities, a modified Mann method, combined with offset osteotomy or resection arthroplasty, was satisfactory for not only improving the foot function, but also preserving the metatarsophalangeal joint mobility.