Ren Yi, Yang Qi, Luo Tim, Lin Jin, Jin Jin, Qian Wenwei, Weng Xisheng, Feng Bin
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China.
Department of Orthopedics, First Hospital of Harbin, Harbin, China.
J Orthop Surg Res. 2021 Jan 27;16(1):84. doi: 10.1186/s13018-021-02232-9.
Previous evidence suggested that perioperative anti-rheumatic therapy for patients receiving total knee arthroplasty (TKA) helped improve postoperative rehabilitation for rheumatoid arthritis (RA), yet long-term effects and outcomes of perioperative drug therapy in TKA presently remain unclear. This study investigated whether perioperative treatment with glucocorticoids (GC) and disease-modifying anti-rheumatic drugs (DMARDs) can improve clinical outcomes for patients with RA undergoing TKA.
Patients between January 2000 and December 2011 were allocated into three groups based on perioperative drug therapy: A, control group (no GC or DMARDs), B, DMARD group (DMARDs given without GC), and C, co-therapy group (DMARDs plus GC). The patients were followed up for average 11.4 years. Baseline characteristics, pre- and post-operative Hospital for Special Surgery score (HSS), laboratory parameters, and complications were recorded by follow-up.
Fifty-six RA patients undergoing 91 TKAs were included in this study. Patients who received perioperative GC with DMARDs (group C) achieved larger/increased range of motion (ROM) (C:122.17 vs A:108.31 vs B:108.07, p = 0.001, partial eta squared (η p) = 0.18) at 1 year, better HSS score (C, 83.01 vs A, 79.23 vs B, 77.35, p = 0.049, η p = 0.067), pain relief (C, 1.09 vs A, 1.17 vs B, 1.75, p = 0.02, η p = 0.094), and ROM (C, 130.81 vs A, 112.82 vs B, 113.58, p = 0.001, η p = 0.142) at latest follow-up comparing with the other treatment groups. No differences were noted in laboratory tests, blood loss, volume of transfusion, or complications among groups.
Compared with the other perioperative anti-rheumatic treatments, the combination of GC and DMARDs results in improved HSS score, better function, larger range of motion, and reduced postoperative pain for TKA patients with RA in the long term. Further investigation is warranted to look for a better understanding of more specific medication effects and strike a good balance between the benefits and complications for long-term pharmacotherapy.
先前的证据表明，接受全膝关节置换术（TKA）的患者围手术期抗风湿治疗有助于改善类风湿关节炎（RA）的术后康复，但目前TKA围手术期药物治疗的长期效果和结局仍不明确。本研究调查了围手术期使用糖皮质激素（GC）和改善病情抗风湿药（DMARDs）治疗能否改善接受TKA的RA患者的临床结局。
将2000年1月至2011年12月期间的患者根据围手术期药物治疗分为三组：A组为对照组（不使用GC或DMARDs），B组为DMARD组（仅使用DMARDs，不使用GC），C组为联合治疗组（DMARDs加GC）。对患者进行平均11.4年的随访。通过随访记录基线特征、术前和术后特殊外科医院评分（HSS）、实验室参数及并发症。
本研究纳入了56例接受91次TKA的RA患者。与其他治疗组相比，围手术期接受GC联合DMARDs治疗的患者（C组）在1年时关节活动度（ROM）更大/增加（C组：122.17，A组：108.31，B组：108.07，p = 0.001，偏 eta 平方（η p）= 0.18），HSS评分更高（C组83.01，A组79.23，B组77.35，p = 0.049，η p = 0.067），疼痛缓解情况更好（C组1.09，A组1.17，B组1.75，p = 0.02，η p = 0.094），在末次随访时ROM也更大（C组130.81，A组112.82，B组113.58，p = 0.001，η p = 0.142）。各组间实验室检查、失血量、输血量或并发症方面未发现差异。
与其他围手术期抗风湿治疗相比，GC与DMARDs联合使用可使接受TKA的RA患者长期HSS评分提高、功能改善、关节活动度增大及术后疼痛减轻。有必要进一步研究以更好地了解更具体的药物作用，并在长期药物治疗的益处和并发症之间取得良好平衡。
