Patient selection and management
RA patients undergoing TKAs at our institute between January 2000 and December 2011 were included in this study, patients receiving operations for other joint diseases (i.e. osteoarthritis, ankylosing spondylosis, etc.) were excluded from research analysis. RA disease status was verified in all patients through history of rheumatologist diagnosis made according to standardized diagnostic criteria before admission. Information regarding GC and DMARD therapy was collected using our institutional arthroplasty database. Patients were organized into 3 treatment groups based on perioperative medication therapy:
A.Control group (no anti-rheumatic drugs used)
B.DMARD group (conventional or biologic DMARD use with no GC)
C.Co-therapy group (DMARD and GC use)
In order to be included in groups B and C, patients must have received consistent management with DMARDs and DMARDs plus GC respectively for a minimum of one year postoperatively. Follow-ups were then conducted through outpatient clinic questionnaires or via telephone. In cases of patient attrition due to death between the follow-up period, most recent health status was obtained in detail from close relatives.
In our study, no patients had been receiving GC monotherapy. Conventional DMARDs treatment was continued during surgery for groups B and C, however all biologic DMARDs were stopped 4 weeks prior to surgery and restarted at least one week postoperatively depending on medication and disease status. Non-steroid anti-inflammatory drugs (NSAIDs) were given in each group as needed to control acute pain.