関節リウマチ患者に対する人工膝関節置換術の効果の分析－局所的効果，全身的疾患活動性，生活の質への影響の比較－

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  • Influence of Total Knee Arthroplasty on Various Parameters Concerning Local and General Disease Activity in Patients with Rheumatoid Arthritis
  • カンセツ リウマチ カンジャ ニ タイスル ジンコウ シツカンセツ チカンジュツ ノ コウカ ノ ブンセキ : キョクショテキ コウカ,ゼンシンテキ シッカン カツドウセイ,セイカツ ノ シツ エ ノ エイキョウ ノ ヒカク

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Objective: To determine the influence of total knee arthroplasty (TKA) on various parameters concerning local and general disease activity in patients with rheumatoid arthritis.<br>Methods: We analyzed the effect of rheumatoid arthritis (RA) disease activity and health-related quality of life. Twenty-two patients with RA were analyzed in this study who underwent TKA. All patients were female, and the average age was 62.4 ± 9.3 years. RA disease activity and quality of life were measured using the Disease Activity Score (DAS) 28, the Simple Disease Activity Index (SDAI), and the modified health assessment questionnaire (mHAQ). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and matrix metalloproteinase-3 (MMP-3) were used as clinical outcome measures. We analyzed the change of drugs including methotrexate (MTX), prednisolone (PSL) and biologic agents; these were measured at three months, six months and one year postoperatively.<br>Results: mHAQ improved from 0.89 to 0.52 by 3 months, and statistically significant differences were found in five items in items of mHAQ. ESR decreased from 38.0 to 31.4 mm/h, CRP decreased from 1.0 to 0.7 mg/dl and MMP-3 decreased from 272.6 to 130.9 ng/ml, respectively. There was an improvement trend post-TKA until one year, but a statistically significant change was found only with MMP-3. There was a statistical improvement in the Visual Analogue Scale (VAS) for pain. A statistically significant difference was also identified for all items including general VAS and doctor VAS. The DAS28-CRP and DAS28-ESR showed a trend towards improvement from three months, which was statistically significant. Conversely, there was no statistical difference for use of MTX or PSL.<br>Conclusion: In this study, TKA was shown to be associated with improvement in disease activity and health-related quality of life measures in patients with RA. In the evaluation of disease activity, a trend towards improvement was shown using the DAS28 and SDAI scoring systems. In addition, levels of MMP-3 were associated with improvement. TKA is associated not only with local but also general disease activity utilizing the “treat to target” concept.

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