Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Division of Orthopaedics, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Department of Medicine 3, Medical University of Vienna, Division of Rheumatology, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Semin Arthritis Rheum. 2020 Apr;50(2):245-251. doi: 10.1016/j.semarthrit.2019.07.011. Epub 2019 Aug 1.
To assess the influence of rheumatoid arthritis (RA) disease activity (DA) on the risk of aseptic loosening after total hip/knee arthroplasty (THA/TKA).
We identified RA patients who underwent THA/TKA and determined their DA using the simplified disease activity index (SDAI). The risk of aseptic loosening was estimated using radiographic signs of component loosening (RCL). We performed Cox regression to estimate RCL based on SDAI, adjusting for therapy. We also investigated a cohort of 2:1 matched osteoarthritis (OA) patients as a control group without systemic inflammation.
We identified 49 RA patients with a history of THA/TKA, of whom 18 (36.7%) showed RCL. SDAI over time was significantly higher in patients with RCL (median; 25th and 75th percentile: 10.8 months; 8.6 and 15.8; vs 7.0 months; 2.7 and 15.5;p = 0.043). In the regression model, each unit of mean SDAI over time significantly increased the risk of RCL (HR 1.125, 95% CI 1.021-1.241;p = 0.018). Patients treated with biological had a lower risk of RCL than those treated with traditional DMARDs (HR 0.192, 95% CI 0.042-0.891;p = 0.035). In the 88 matched OA patients, the RCL rate was significantly lower than in the RA group (13.6%;p = 0.002).
Higher inflammatory DA increases the risk for radiographic loosening after THA/TKA in patients with RA. The significantly lower risk in patients with OA further underlines the potential role of inflammatory DA. In the context of treating RA to target, the presence of an arthroplasty might be considered as an indication for more stringent control of DA.
评估类风湿关节炎（RA）疾病活动度（DA）对全髋关节/膝关节置换术后无菌性松动的风险的影响。
我们确定了接受 THA/TKA 的 RA 患者，并使用简化疾病活动指数（SDAI）确定他们的 DA。无菌性松动的风险通过组件松动的放射学迹象（RCL）来估计。我们使用 Cox 回归根据 SDAI 估计 RCL，调整治疗因素。我们还研究了一组 2:1 匹配的骨关节炎（OA）患者作为没有全身炎症的对照组。
我们确定了 49 例有 THA/TKA 病史的 RA 患者，其中 18 例（36.7%）出现了 RCL。有 RCL 的患者的 SDAI 随时间的变化明显更高（中位数；25%和 75%百分位数：10.8 个月；8.6 和 15.8；vs 7.0 个月；2.7 和 15.5；p=0.043）。在回归模型中，每个时间点平均 SDAI 的单位增加都会显著增加 RCL 的风险（HR 1.125，95%CI 1.021-1.241；p=0.018）。与接受传统 DMARDs 治疗的患者相比，接受生物制剂治疗的患者 RCL 的风险更低（HR 0.192，95%CI 0.042-0.891；p=0.035）。在 88 例匹配的 OA 患者中，RCL 发生率明显低于 RA 组（13.6%；p=0.002）。
RA 患者的炎症性 DA 越高，THA/TKA 后出现放射学松动的风险就越大。OA 患者的风险显著降低进一步强调了炎症性 DA 的潜在作用。在以目标为导向治疗 RA 的背景下，关节置换术的存在可能被视为更严格控制 DA 的指征。
