Better clinical outcome of total knee arthroplasty for rheumatoid
arthritis with glucocorticoids and disease-modifying anti-rheumatic
drugs after an average of 11.4-year follow-up
Abstract
Objectives: This study investigated whether perioperative treatment with
glucocorticoids (GC) and disease-modifying anti-rheumatic drugs (DMARDs)
can improve clinical outcomes and reduce long-term complications for
patients with rheumatoid arthritis (RA) undergoing total knee
arthroplasty (TKA). Methods: Patients 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 and received questionnaires at the
latest follow-up. Baseline characteristics, pre- and post-operative HSS
knee score, laboratory parameters, and surgical complications were
collected and analyzed. Results: 56 RA patients undergoing 91 TKAs were
included in this study. The average follow-up duration was 11.4 years.
Patients who received perioperative GC with DMARDs (group C) achieved
better HSS score (C:84.04 vs A:78.96 vs B:76.50, p=.008), pain relief
(VAS: C: 1.12 vs B: 1.73, p=0.02), higher functional assessment (C:16.17
vs B:13.23, p=0.03) and range of motion (C:132.15 vs A:112.57 vs
B:112.51, p<0.001) compared the other treatment groups at time
of latest follow-up. Aside from greater post-operative hemoglobin seen
in group A compared to group B (P=0.04), no other differences were noted
in laboratory tests, blood loss and transfusion, short-term or long-term
complications between treatment groups. Conclusions: Perioperative
treatment with GC combined DMARDs for RA patients is associated with
improved HSS score, better function and range of motion, and reduced
postoperative pain in the long term when compared to treatment with
DMARDs alone or management without anti-rheumatic medication.