Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Mod Rheumatol. 2022 Oct 15;32(6):1047-1053. doi: 10.1093/mr/roab114.
Whether the characteristics of patients with rheumatoid arthritis (RA) undergoing total knee arthroplasty (TKA) have changed in the era of biologic disease-modifying antirheumatic drugs (bDMARDs) is unclear. We compared the radiographic findings of the knees in TKA recipients with RA before and after the introduction of bDMARDs.
Consecutive patients who underwent primary TKA between 1999 and 2002 (115 knees; 79 patients, group A) and between 2013 and 2017 (117 knees; 95 patients, group B) were retrospectively evaluated. Clinical data, including disease duration, medication, C-reactive protein, erythrocyte sedimentation rate, and rheumatoid factor, were collected. The Larsen classification, joint space narrowing (JSN), bone erosion, and geode and osteophyte formation were evaluated on preoperative radiographs.
Osteophyte formation was significantly increased, and bone erosion and geode formation were significantly decreased in group B. In addition, medial-dominant JSN was significantly increased, and bicompartmental JSN was significantly decreased in group B. Medial-dominant JSN was positively and bone erosion was negatively associated with osteophyte formation.
Following the introduction of bDMARDs, typical radiographic findings of rheumatoid knees have decreased, and secondary osteoarthritis-like changes, characterized by osteophyte formation and medial-dominant JSN, have increased in the knees of TKA recipients.
在生物改善病情抗风湿药物（bDMARDs）时代，接受全膝关节置换术（TKA）的类风湿关节炎（RA）患者的特征是否发生了变化尚不清楚。我们比较了 bDMARDs 引入前后 TKA 接受者 RA 膝关节的影像学表现。
回顾性分析了 1999 年至 2002 年（115 膝；79 例患者，A 组）和 2013 年至 2017 年（117 膝；95 例患者，B 组）期间接受初次 TKA 的连续患者。收集了临床数据，包括疾病持续时间、药物、C 反应蛋白、红细胞沉降率和类风湿因子。在术前 X 线片上评估了 Larsen 分级、关节间隙狭窄（JSN）、骨侵蚀、骨质增生和骨赘形成。
B 组骨赘形成明显增加，骨侵蚀和骨质增生明显减少。此外，B 组内侧为主的 JSN 明显增加，双间室 JSN 明显减少。内侧为主的 JSN 与骨赘形成呈正相关，而骨侵蚀与骨赘形成呈负相关。
bDMARDs 引入后，RA 膝关节的典型影像学表现减少，而 TKA 接受者膝关节中以骨赘形成为特征的继发性骨关节炎样改变，即内侧为主的 JSN 增加。
