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Rheumatoid Arthritis Flares After Total Hip and Total Knee Arthroplasty: Outcomes at One Year
Author(s) -
Goodman Susan M.,
Mirza Serene Z.,
DiCarlo Edward F.,
PearceFisher Diyu,
Zhang Meng,
Mehta Bella,
Donlin Laura T.,
Bykerk Vivian P.,
Figgie Mark P.,
Orange Dana E.
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.24091
Subject(s) - medicine , osteoarthritis , arthroplasty , rheumatoid arthritis , physical therapy , logistic regression , arthritis , concordance , surgery , alternative medicine , pathology
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 [ DAS 28] 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 DAS 28 predicted 1‐year HOOS / KOOS pain and function; each 1‐unit increase in DAS 28 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.