OBJECTIVE: Most patients with rheumatoid arthritis (RA) undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) have active RA and report postoperative flares; whether RA disease activity or flares increase the risk of worse pain and function scores 1 year later is unknown. METHODS: Patients with RA were enrolled before THA/TKA. Patient-reported outcomes, including the Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS) and physician assessments of disease characteristics and activity (Disease Activity Score in 28 joints [DAS28] and Clinical Disease Activity Index), were collected before surgery. Patient-reported outcomes were repeated at 1 year. Postoperative flares were identified using the RA Flare Questionnaire weekly for 6 weeks and were defined by concordance between patient report plus physician assessment. We compared baseline characteristics and HOOS/KOOS scores using 2-sample t-test/Wilcoxon's rank sum test as well as chi-square/Fisher's exact tests. We used multivariate linear and logistic regression to determine the association of baseline characteristics, disease activity, and flares with 1-year outcomes. RESULTS: One-year HOOS/KOOS scores were available for 122 patients (56 with THA and 66 with TKA). Although HOOS/KOOS pain was worse for patients who experienced a flare within 6 weeks of surgery, absolute improvement was not different. In multivariable models, baseline DAS28 predicted 1-year HOOS/KOOS pain and function; each 1-unit increase in DAS28 worsened 1-year pain by 2.41 (SE 1.05; P = 0.02) and 1-year function by 4.96 (SE 1.17; P = 0.0001). Postoperative flares were not independent risk factors for pain or function scores. CONCLUSION: Higher disease activity increased the risk of worse pain and function 1 year after arthroplasty, but postoperative flares did not.
OBJECTIVE: Most patients with rheumatoid arthritis (RA) undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) have active RA and report postoperative flares; whether RA disease activity or flares increase the risk of worse pain and function scores 1 year later is unknown. METHODS:Patients with RA were enrolled before THA/TKA. Patient-reported outcomes, including the Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS) and physician assessments of disease characteristics and activity (Disease Activity Score in 28 joints [DAS28] and Clinical Disease Activity Index), were collected before surgery. Patient-reported outcomes were repeated at 1 year. Postoperative flares were identified using the RA Flare Questionnaire weekly for 6 weeks and were defined by concordance between patient report plus physician assessment. We compared baseline characteristics and HOOS/KOOS scores using 2-sample t-test/Wilcoxon's rank sum test as well as chi-square/Fisher's exact tests. We used multivariate linear and logistic regression to determine the association of baseline characteristics, disease activity, and flares with 1-year outcomes. RESULTS: One-year HOOS/KOOS scores were available for 122 patients (56 with THA and 66 with TKA). Although HOOS/KOOS pain was worse for patients who experienced a flare within 6 weeks of surgery, absolute improvement was not different. In multivariable models, baseline DAS28 predicted 1-year HOOS/KOOS pain and function; each 1-unit increase in DAS28 worsened 1-year pain by 2.41 (SE 1.05; P = 0.02) and 1-year function by 4.96 (SE 1.17; P = 0.0001). Postoperative flares were not independent risk factors for pain or function scores. CONCLUSION: Higher disease activity increased the risk of worse pain and function 1 year after arthroplasty, but postoperative flares did not.
Authors: Susan M Goodman; Bryan Springer; Gordon Guyatt; Matthew P Abdel; Vinod Dasa; Michael George; Ora Gewurz-Singer; Jon T Giles; Beverly Johnson; Steve Lee; Lisa A Mandl; Michael A Mont; Peter Sculco; Scott Sporer; Louis Stryker; Marat Turgunbaev; Barry Brause; Antonia F Chen; Jeremy Gililland; Mark Goodman; Arlene Hurley-Rosenblatt; Kyriakos Kirou; Elena Losina; Ronald MacKenzie; Kaleb Michaud; Ted Mikuls; Linda Russell; Alexander Sah; Amy S Miller; Jasvinder A Singh; Adolph Yates Journal: Arthritis Care Res (Hoboken) Date: 2017-06-16 Impact factor: 4.794
Authors: Susan M Goodman; Amy S Miller; Marat Turgunbaev; Gordon Guyatt; Adolph Yates; Bryan Springer; Jasvinder A Singh Journal: Arthritis Care Res (Hoboken) Date: 2017-06-16 Impact factor: 4.794
Authors: T Iwata; H Ito; M Furu; M Hashimoto; T Fujii; M Ishikawa; M Azukizawa; Y Hamamoto; T Mimori; H Akiyama; S Matsuda Journal: Scand J Rheumatol Date: 2016-02-06 Impact factor: 3.641
Authors: Susan M Goodman; Vivian P Bykerk; Edward DiCarlo; Ryan W Cummings; Laura T Donlin; Dana E Orange; Annie Hoang; Serene Mirza; Michael McNamara; Kayte Andersen; Susan J Bartlett; Jackie Szymonifka; Mark P Figgie Journal: J Rheumatol Date: 2018-03-15 Impact factor: 4.666
Authors: Anand Dusad; Sofia Pedro; Ted R Mikuls; Curtis W Hartman; Kevin L Garvin; James R O'Dell; Kaleb Michaud Journal: Arthritis Rheumatol Date: 2015-09 Impact factor: 10.995