Does endoprosthetic replacement of large joints improve quality of life in patients with rheumatoid arthritis?

Objective: to analyze the course of rheumatoid arthritis (RA), to assess its previous therapy, and to evaluate the efficiency of endoprosthetic replacement of knee or hip joints (EKJ or EHJ).
Subjects and methods. The study enrolled 50 patients with RA who had undergone EKJ (Group 1; n = 32) or EKJ (Group 2; n = 18); their mean age was 51.8±11.6 and 48.7±8.5 years and the disease duration was 16.5±7.8 and 15.5±7.5 years, respectively. Their quality of life (QL) was estimated by the EQ-5D and SF-36 questionnaires; joint functional capacity was assessed by the HAQ index and the Harris and Insall scales. Results and discussion. Before surgical treatment, the majority of patients took methotrexate (MT) in a weekly dose of 7.5-10 mg, which was prescribed 7-10 years after the disease onset. Oral glucocorticoids (GC) were given to 65.4 and 84.6% of the patients of Groups 1 and 2, respectively. Six months after endoprosthetic replacement, there was functional improvement: the HAQ index decreased from 1.64±0.7 to 1.40±0.6 after EKJ (p = 0.003) and from 2.07±0.6 to 1.72-0.7 after EHJ (p = 0.04). The EQ-5D QL index increased from 0.52 [0.0- 0.61] to 0.59 [0.52-0.69] scores after EKJ (p = 004) and from -0.02 [-0.02-0.52] to 0.52 [-0.02-0.62] scores after EHJ (p = 0.096). There was a significant improvement in the SF-36 physical component summary (PCS): APCS = 4.3 (p = 0.04) after EKJ and APCS = 5.7 (p = 0.02) after EHJ and a trend towards stabilization of the patients' mental status.
Conclusion. The majority of patients had not initially received adequate disease-modifying anti-inflammatory therapy for many years. Endoprosthetic replacement of the lower limb joints in the first 6 months after surgery improved the functional capacity of the operated joint, by increasing QL in the patients as a whole. There was no substantial decrease in global disease activity 6 months following surgery.

rheumatoid arthritis, endoprosthetic replacement of knee or hip joints, quality of life estimation

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