Long-Term Implant Fracture Rates Following Silicone Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis.

PURPOSE: The primary objective of this study was to compare the long-term survival rates of silicone metacarpophalangeal (MCP) arthroplasties between two major implants in patients with rheumatoid arthritis, using implant fracture as an end point. We also evaluated the difference in postoperative function between patients with fractured and intact implants as a secondary objective. METHODS: A retrospective cohort study was conducted on 372 fingers of 133 hands that underwent silicone MCP arthroplasty between January 2000 and June 2019 (mean follow-up, 7.6 years). The survival rates of Swanson-type and Sutter-type implants were compared, using implant fracture as the end point after a radiographic evaluation. Clinical measures and upper limb functional assessments using the Disabilities of the Arm, Shoulder, and Hand (DASH) score were performed in the nested cohort. RESULTS: The 10.6-year survival rates for implant fracture of Swanson- and Sutter-type implants were 86.2% and 9.4%, respectively, with significantly higher survival noted for Swanson-type implants. The Sutter-type implant showed increased susceptibility to fracture in all four fingers compared to the Swanson-type implant. Implant fractures were primarily observed at the stem-hinge junction. There were no significant differences in upper limb function between the fractured and intact implant groups. CONCLUSIONS: Sutter-type implants were found to be more prone to fracture compared with Swanson-type implants. However, implant fractures did not significantly affect upper limb function. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IV.

Intensive treatment for the progression of joint damage in rheumatoid arthritis patients with low disease activity or remission.

OBJECTIVES: To investigate the effects of intensive treatment on joint damage in patients with rheumatoid arthritis (RA) showing progression of joint damage and low disease activity or remission. METHODS: Eighty-nine patients who had change in the van der Heijde modified total Sharp score (TSS) of >0.5 points at baseline when compared with the score 1 year ago were enrolled and categorized into two groups to receive intensive (intensive group) or current (current group) treatment. The intensive and current groups were compared for change (Δ) from baseline to 1 year of erosion score, joint space narrowing score, and TSS. RESULTS: The ΔTSS values at 1 year in the intensive and current groups were 0.67 ± 1.09 and 1.79 ± 1.70, respectively (P < 0.001). In the intensive and current groups, the ΔTSS ≤ 0.5 at 1 year were 66.7% and 32.4%, respectively (P = 0.010). CONCLUSIONS: The intensive treatment was more effective at suppressing joint damage than the current treatment. The progression of joint damage is an important target to consider for intensive treatment.

Features of patients with rheumatoid arthritis whose debut joint is a foot or ankle joint: A 5,479-case study from the IORRA cohort.

BACKGROUND: Foot and ankle joint disorders are serious issues for patients with rheumatoid arthritis (RA). We compared the differences between patients with RA whose first symptom involved a foot or ankle joint (FOOT group) versus other joints (non-FOOT group) within the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort in our institute. PATIENTS AND METHODS: In the IORRA survey conducted in April 2016, patients were invited to complete six questionnaires about their first symptom at RA onset, current foot or ankle symptoms, daily living activities, and mental health. Disease activity, clinical laboratory variables, functional disability, quality of life, use and ratio of anti-inflammatory and antirheumatic drugs, daily living activities and mental health were compared between the two groups. RESULTS: Among 5,637 Japanese patients with RA who participated in the IORRA survey on April 2016, 5,479 (97.2%) responded to the questionnaire regarding their debut joint. Of these patients, 2,402 (43.8%) reported that their first symptom of RA involved a foot or ankle joint. The FOOT group (n = 2,164) had higher disease activity, higher disabilities, lower quality of life, lower activities of daily living, and poorer mental health and used anti-inflammatory drugs at a higher rate and at higher doses compared with the non-FOOT group (n = 2,164). On the other hand, the use of medications to suppress the disease activity of RA was similar between the groups. CONCLUSION: Clinicians should pay more attention to foot and ankle joints in daily practice so as not to underestimate the disease activity of RA.

Effects of denosumab treatment on bone mineral density and joint destruction in patients with rheumatoid arthritis.

We aimed to investigate the efficacy of denosumab for rheumatoid arthritis (RA). This study enrolled 70 RA patients who received denosumab 60 mg subcutaneous injection at baseline and at 6 months. Bone mineral densities (BMD) of the lumbar spine, total hip, femoral neck, and hand were measured by dual energy X-ray absorptiometry. Changes in total modified Sharp score (mTSS), erosion (EN) score, and joint space narrowing score at baseline from 12 months before and at 12 months from baseline. The mean values of BMD of the lumbar spine, total hip, femoral neck, and hand significantly increased by 7.3, 4.7, 3.9, and 5.4%, respectively, at 12 months. At 12 months from baseline, there were significant decreases in the values of mTSS (1.13 vs. 0.59; p = 0.002) and EN score (0.40 vs. 0.07; p < 0.001), compared with the values at baseline from 12 months before. The existing combined modality therapy with denosumab might be effective for osteoporosis and joint destruction in patients with RA.

Negative pressure wound therapy and skin grafting for necrotizing fasciitis in a patient with rheumatoid arthritis treated with abatacept: A case report.

Herein, we present a case of necrotizing fasciitis (NF) in a patient with rheumatoid arthritis (RA) treated with abatacept. Cultures of the patient's leg effusion revealed group A Streptococcus. Treatment included antibiological drugs, repeat debridement, negative pressure wound therapy (NPWT), and skin grafting. This case highlights the need for suspicion of severe bacterial infection for early diagnosis and effective treatment. NF with RA can be treated effectively with repeat debridement and NPWT.

Hip structure analysis by DXA of teriparatide treatment: A 24-month follow-up clinical study.

OBJECTIVE: The objective of this study was to perform a hip structure analysis (HSA) of teriparatide (TPTD) treatment in women with postmenopausal osteoporosis. METHODS: The study included 96 patients with postmenopausal osteoporosis and received 20 µg TPTD daily. HSA was performed by dual-energy X-ray absorptiometry. RESULTS: The percent changes from baseline for the cross-sectional moment of inertia, section modulus, buckling ratio, and femoral strength index based on HSA results were 9.8% (p < 0.01), 10.7%, 3.3%, and 14.9% (p < 0.01), respectively, at 24 months. CONCLUSION: Based on the HSA results obtained with DXA, TPTD was effective for hip structures.

Tramadol hydrochloride/acetaminophen combination versus non-steroidal anti-inflammatory drug for the treatment of perioperative pain after total knee arthroplasty: A prospective, randomized, open-label clinical trial.

BACKGROUND: While many of the commonly used treatments for perioperative pain after total knee arthroplasty (TKA) have been recognized as effective, there is still insufficient evidence for oral medication. In orthopedics, non-steroidal anti-inflammatory drugs (NSAIDs) have been commonly used for perioperative pain; however, serious adverse events have been reported. Conversely, tramadol hydrochloride/acetaminophen combination (TRAM/APAP) therapy has been shown to reduce pain, particularly for chronic pain in Japan. This study aimed to determine TRAM/APAP efficacy in comparison with NSAIDs for perioperative pain after TKA. METHODS: Two hundred eighty patients were enrolled in this study; 137 patients were treated with TRAM/APAP, and 143 patients were treated with NSAID from postoperative (PO) day 2. The primary endpoint was a comparison between the pain visual analog scale (VAS) change from baseline (PO day 2) and PO day 4, day 7, day 10, and day 14. The second endpoint was the number of days until the patient achieved independence from cane walking. RESULTS: Analysis of endpoints included 130 and 139 patients in the TRAM/APAP and NSAID groups, respectively. The pain VAS change in the TRAM/APAP group on any of the measurement days was significantly improved compared with the NSAID group (P < 0.01). Similarly, the TRAM/APAP group achieved cane-walking independence significantly faster than the NSAID group (P < 0.01). CONCLUSION: Efficacy for perioperative pain management after TKA of TRAM/APAP was shown to be superior to that of NSAID; TRAM/APAP was also effective in improving the progress of rehabilitation.

Platelet-rich plasma for the reduction of blood loss after total knee arthroplasty: a clinical trial.

PURPOSE: This study aims to clarify the effect of intra-articular platelet-rich plasma (PRP) in total knee arthroplasty (TKA) in preventing postoperative bleeding. METHODS: There were 315 knees that underwent TKA and were included in this study. The subjects were randomized by paramedical staffs. These were divided into the PRP group who received intra-articular PRP intraoperatively (n = 109) and the control group who did not (n = 206). We measured postoperative blood loss (drain bag volume), estimated blood loss, and change in hemoglobin (Hb) value at postoperative day 1, 2, 4, and 7. The clinical data were compared between the PRP group and the control group. RESULTS: The mean postoperative blood loss of 446.9 ± 149.7 mL in the PRP group was significantly less than that in the control group (550.7 ± 178.1 mL, p < 0.001). The mean postoperative estimated blood loss of 437.5 ± 221.3 mL in the PRP group was significantly less than that in the control group (552.2 ± 336.3 mL, p < 0.01). The mean change in Hb value (mg/dL) from baseline was -1.45 in the PRP group and -1.85 in the control group at postoperative 1 day (p < 0.05), -1.74 in the PRP group and -2.11 in the control group at postoperative day 2 (p < 0.05), -2.30 in the PRP group and -2.47 in the control group at postoperative day 4 (p < 0.05), and -1.98 in the PRP group and -2.46 in the control group at postoperative day 7 (p < 0.01). CONCLUSION: In this prospective randomized study, those that received PRP after TKA had significantly less postoperative blood loss and change in Hb level. PRP appears to be effective in reducing postoperative bleeding in TKA.

Scoliosis-related factors in patients with rheumatoid arthritis: A cross-sectional study.

OBJECTIVES: This study aimed to identify the prevalence of scoliosis and scoliosis-related factors of rheumatoid arthritis (RA). METHODS: In this study, 411 patients who underwent coronal total spine and lower limb radiography were enrolled. Patients with a Cobb angle ≥10° were diagnosed with scoliosis. Statistical analysis was performed to compare between patients with and those without scoliosis, and between patients without scoliosis and those with a Cobb angle >20°. RESULTS: The prevalence of scoliosis in patients with RA was 30.7%. The mean Cobb angles were 8.5° ± 7.2° in all the patients, 16.1° ± 8.6° in patients with scoliosis, and 5.1° ± 2.3° in patients without scoliosis. According to a multivariate analysis, the scoliosis-related factors of RA were age and vertebral fracture. Significant differences in age, corticosteroid use, and malalignment of lower limbs were observed between patients with a Cobb angle >20° and those without scoliosis. CONCLUSIONS: With RA treatment, the need for corticosteroid use is reduced and vertebral fracture is prevented. Moreover, the joints and spinal and lower limb alignments should be examined.

The efficacy of abatacept in Japanese patients with rheumatoid arthritis: 104 weeks radiographic and clinical results in clinical practice.

OBJECTIVE: We aimed to assess the efficacy of abatacept in Japanese patients with rheumatoid arthritis (RA) in clinical practice. METHODS: We examined 92 patients who received abatacept for 104 weeks. Analysis of radiographic efficacy was conducted using van der Heijde-modified total Sharp score (mTSS). Disease activity score was assessed using disease activity score in 28 joints (DAS28) and simplified disease activity index (SDAI) by last observation carried forward. RESULTS: The change in mTSS was 0.61 at 52 weeks and 0.27 at 52-104 weeks. Structural remission occurred in 64.9% at 52 weeks and 76.6% at 104 weeks. The significant risk factors for joint damage progression at 52 weeks were prednisolone use, baseline C-reactive protein level (CRP), and erythrocyte sedimentation rate (ESR), as well as average DAS28-CRP and DAS28-ESR scores, SDAI, CRP, ESR, and matrix metalloproteinase-3 (MMP-3) levels. The clinical remission rates were 47.8% by DAS28-CRP, 39.1% by DAS28-ESR, and 30.4% by SDAI at 52 weeks, were 59.8% by DAS28-CRP, 48.9% by DAS28-ESR, and 43.5% by SDAI at 104 weeks. CONCLUSION: This study suggested efficacy of abatacept treatment in Japanese patient with RA for 104 weeks in daily clinical practice. Abatacept lead to suppress joint destruction for 104 weeks.

Validity and responsiveness of a self-administered foot evaluation questionnaire in rheumatoid arthritis.

OBJECTIVES: A self-administered foot evaluation questionnaire (SAFE-Q) was developed by the Japanese Society for Surgery of the Foot (JSSF). The aim of this study is to evaluate the validity and responsiveness of the SAFE-Q in patients with rheumatoid arthritis (RA). METHODS: In total, 180 patients with RA answered the SAFE-Q. Of 180 patients, 34 answered the SAFE-Q twice, preoperatively and postoperatively, to assess responsiveness. Construct validity was tested by comparing the 5 SAFE-Q subscales and the JSSF standard rating system for the RA foot and ankle scale (JSSF-RA), a Japanese version of the Health Assessment Questionnaire (JHAQ), disease activity score in 28 joints (DAS28), simplified disease activity index (SDAI), and clinical disease activity index (CDAI). Responsiveness was examined by calculating the standardized response mean (SRM) and effect size (ES) 3 months after surgery. RESULTS: There were moderate correlations between the SAFE-Q and the JSSF-RA and JHAQ. Conversely, a low correlation was observed between the SAFE-Q and DAS28, SDAI, and CDAI. The responsiveness was high, with an SRM of 0.9 and ES of 0.7 for pain subscales. CONCLUSION: SAFE-Q is a useful tool for assessing the foot and ankle in RA patients.

Recent trends in orthopedic surgery aiming to improve quality of life for those with rheumatoid arthritis: data from a large observational cohort.

OBJECTIVE: To describe current trends in the numbers of rheumatoid arthritis (RA)-related surgeries. METHODS: The number of operations was determined for patients with RA in a large observational cohort [Institute of Rheumatology, Rheumatoid Arthritis (IORRA)] enrolled from 2001 to 2012. RESULTS: The total number of operations peaked in 2002 and gradually decreased thereafter, but began to increase again in 2008. The number of total knee replacements has decreased since 2003, while the number of wrist and foot arthroplasties and the number of artificial finger prosthesis surgeries have increased gradually. CONCLUSION: Our results suggest that the number of orthopedic surgeries may change in response to changes in the drug therapy for RA.