A Study on the Alignment of the Lower Extremities in Patients with Rheumatoid Arthritis

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  • SONOBE Masato
    Department of Orthopaedic Surgery, Toho University Sakura Medical Center
  • 中島 新
    Department of Orthopaedic Surgery, Toho University Sakura Medical Center
  • 高橋 宏
    Department of Orthopaedic Surgery, Toho University Sakura Medical Center
  • 赤津 頼一
    Department of Orthopaedic Surgery, Toho University Sakura Medical Center
  • 齊藤 淳也
    Department of Orthopaedic Surgery, Toho University Sakura Medical Center
  • 山田 学
    Department of Orthopaedic Surgery, Toho University Sakura Medical Center
  • 戸口 郁
    Department of Orthopaedic Surgery, Toho University Sakura Medical Center
  • 中野 志保
    Department of Orthopaedic Surgery, Toho University Sakura Medical Center
  • 中川 晃一
    Department of Orthopaedic Surgery, Toho University Sakura Medical Center
  • 中村 卓司
    東邦大学医療センター大森病院 整形外科

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Other Title
  • 関節リウマチ患者の下肢アライメントに影響する因子の検討
  • カンセツ リウマチ カンジャ ノ カシ アライメント ニ エイキョウ スル インシ ノ ケントウ

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Abstract

<p>Objective: The purpose of this study was to investigate the factors influencing the alignment of the lower extremities in patients with rheumatoid arthritis.</p><p>Methods: The study included 83 knees in 66 patients with rheumatoid arthritis (RA) who underwent primary TKA between June 2010 and March 2018 inclusive at our hospital. Patients included six men and 60 women, with a mean onset of RA at 53.1 years and the mean duration of RA of 14.5 years, respectively. They were classified into three groups (valgus, neutral, varus) by femorotibial angle (FTA). We investigated the relationship between the alignment of the lower extremities and the following factors: gender, body mass index, age at onset of RA, era of onset of RA (before or after the year 2000), duration of RA, rheumatoid factor, anti-cyclic citrullinated peptide antibody, osteoporosis, use of glucocorticoid agents, methotrexate and biologic therapy, C-reactive protein, matrix metalloproteinase-3, and DAS28-ESR score. We compared these factors among the three groups.</p><p>Results: Before TKA, the FTA was distributed between 150 and 203º (mean, 178.1º). Varus deformity was observed in 50.6% of the patients, valgus deformity in 26.5%, and neutral in 22.9%, respectively. Onset of RA of the varus group occurred later than in the neutral and valgus groups. In other words, patients with eldery onset RA (EORA) showed varus deformity of the knee (VDK), whereas juvenile onset RA (JORA) demonstrated valgus or neutral changes. Forty percent of patients whose onset of RA was before the year 2000 showed VDK, whereas only 16.7% of patients whose onset of RA occurred after the year 2000 showed such changes. In patients whose onset of RA was before the year 2000 showed a decreased frequency of VDK compared to after the year 2000. In addition, the frequency of varus and neutral knee changes increased.</p><p>Conclusion: Patients with EORA showed varus deformity of the knee, whereas patients with JORA showed valgus or neutral changes. Recently, the frequency of VDK has decreased compared to before the year 2000, whereas the frequency of varus knee and neutral knee changes have increased.</p>

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