SHOULD DISEASE-MODIFYING THERAPY BE STOPPED IN PATIENTS WITH RHEUMATOID ARTHRITIS BEFORE ENDOPROSTHETIC JOINT REPLACEMENT?
https://doi.org/10.14412/1995-4484-2011-1460
Abstract
Objective: to analyze disease activity, functional state, quality of life (QL), and the frequency of infectious complications in methotrexate (MT) – or leflunomide (LF)-treated patients with rheumatoid arthritis (RA) who had undergone endoprosthetic replacement of the large joints of the lower limbs.
Subjects and methods. One hundred and fourteen patients with RA who had undergone endoprosthetic replacement of the knee and hip joints were divided into 3 groups: 1) 36 patients who continuously received MT or LF in the perioperative period; 2) 42 patients who dis- continued MT or LF 2 and 4 weeks, respectively, prior to surgery; 3) 36 patients who took no disease-modifying anti-rheumatic drugs (DMARDs) within 12 months before surgery. Disease activity was estimated by the DAS28 index. QL was determined using the EQ-5D questionnaire and functional capacity was estimated by the HAQ index.
Results and discussion. In all the groups, there was a preponderance of patients with moderate RA activity (more than 60%). In Groups 1 and 2, the mean dose of MT was about 10 mg weekly and that of LF was 20 mg daily. The use duration of glucocorticoids (GC) and their doses were comparable in all the groups. Twelve months after surgery, DAS28 significantly reduced from 4.22±1.08 to 3.58±1.07 months in Group 1 (p = 0.01); in Group 2, the decrease was insignificant: from 4.17±1.17 to 3.80±1.15 (p > 005); in Group 3, RA activity remained as before. All the groups achieved 50% functional improvement; better results were obtained in the group of patients who continued to use DMARDs in the perioperative period (∆HAQ=-0.67). The difference in the Eq-5D index corresponded to a moderate QL improvement: ∆EQ-5D = 0.28, 0.29, and 0.31 in Groups 1, 2, and 3, respectively (p < 0.05). There were no significant group differences. Deep infection in the endoprosthetic replacement area was detected in 2.8, 2.4, and 8.3% of cases, respectively (p > 005).
Conclusion. Continuous use of MT and LF leads to a reduction in total disease activity and to functional improvement in patients with RA after endoprosthetic joint replacement, without increasing the frequency of infectious complications.
About the Authors
N. A. Savenkova
lifequality@yandex.ru
V. N. Amirdzhanova
S. A. Makarov
A. L. Logunov
M. A. Makarov
V. V. Kolomatsky
D. V. Goryachev
References
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Savenkova N.A., Amirdzhanova V.N., Makarov S.A., Logunov A.L., Makarov M.A., Kolomatsky V.V., Goryachev D.V. SHOULD DISEASE-MODIFYING THERAPY BE STOPPED IN PATIENTS WITH RHEUMATOID ARTHRITIS BEFORE ENDOPROSTHETIC JOINT REPLACEMENT? Rheumatology Science and Practice. 2011;49(5):46-50. (In Russ.) https://doi.org/10.14412/1995-4484-2011-1460
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