Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
Nagoya J Med Sci. 2022 May;84(2):286-300. doi: 10.18999/nagjms.84.2.286.
This study aimed to investigate changes in and factors associated with perioperative serum C-reactive protein (CRP) levels in rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA) in the biologic era. A total of 173 patients (228 knees) with RA underwent elective primary TKA at our institute between January 1, 2006 and December 31, 2018. Of these, 214 cases among 161 patients were examined in this retrospective study after excluding 3cases among 3 patients who developed postoperative complications and 11 cases among 9 patients who were treated with tocilizumab. Factors associated with changes in CRP levels between baseline (preoperative) and day 7 after TKA [ΔCRP (0-7days)] were assessed by multiple regression analysis. Median (interquartile range) CRP levels were 0.69 (0.21, 1.82) mg/dl preoperatively, 5.66 (4.21, 7.61) mg/dl on postoperative day 1, 12.75 (9.79, 16.74) mg/dl on postoperative days 3-4, 3.26 (2.21, 4.85) mg/dl on postoperative day 7, and 0.87 (0.45, 1.81) mg/dl on postoperative day 14. Multivariate regression analysis revealed that body mass index ≥25 [partial regression coefficient (B)=1.03, =0.012] and use of glucocorticoids (B=-0.86, =0.017) were independently associated with ΔCRP (0-7days), whereas use of methotrexate and targeted drug modifying antirheumatic drugs and preoperative CRP levels (an objective biomarker of RA activity) were not. In conclusion, serum CRP levels increased rapidly after TKA and peaked on postoperative days 3-4, followed by a return to preoperative levels by postoperative day 14 in patients with RA. Obesity and the use of glucocorticoids were independently associated with changes in CRP levels.
本研究旨在探讨生物制剂时代类风湿关节炎（RA）患者行全膝关节置换术（TKA）围手术期血清 C 反应蛋白（CRP）水平的变化及其相关因素。2006 年 1 月 1 日至 2018 年 12 月 31 日，我院对 173 例（228 膝）RA 患者行择期初次 TKA。在排除术后发生并发症的 3 例患者和 9 例使用托珠单抗治疗的患者中的 11 例后，对 161 例患者中的 214 例进行了回顾性研究。采用多元回归分析评估了 CRP 水平在基线（术前）和 TKA 后第 7 天（CRP0-7d）变化的相关因素。术前 CRP 中位数（四分位数间距）为 0.69（0.21，1.82）mg/dl，术后第 1 天为 5.66（4.21，7.61）mg/dl，术后第 3-4 天为 12.75（9.79，16.74）mg/dl，术后第 7 天为 3.26（2.21，4.85）mg/dl，术后第 14 天为 0.87（0.45，1.81）mg/dl。多元回归分析显示，体重指数≥25（偏回归系数（B）=1.03，=0.012）和使用糖皮质激素（B=-0.86，=0.017）与 CRP0-7d 独立相关，而使用甲氨蝶呤和靶向药物改善抗风湿药物以及术前 CRP 水平（RA 活动的客观生物标志物）则不相关。结论：RA 患者 TKA 后 CRP 水平迅速升高，术后第 3-4 天达到高峰，术后第 14 天恢复至术前水平。肥胖和糖皮质激素的使用与 CRP 水平的变化独立相关。
