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J Rheumatol. 2018 May;45(5):604-611. doi: 10.3899/jrheum.170366. Epub 2018 Mar 15.

Flares in Patients with Rheumatoid Arthritis after Total Hip and Total Knee Arthroplasty: Rates, Characteristics, and Risk Factors.

Author information

1
From the Departments of Rheumatology and Orthopedics, Hospital for Special Surgery; Rockefeller University, New York, New York, USA; Mount Sinai Hospital, Rebecca McDonald Center for Arthritis and Autoimmunity, Toronto, Ontario; the departments of Clinical Epidemiology and Rheumatology, McGill University, Montreal, Quebec, Canada; the Department of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. goodmans@hss.edu.
2
S.M. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery; V.P. Bykerk, MD, Department of Rheumatology, Hospital for Special Surgery, and Mount Sinai Hospital, Rebecca McDonald Center for Arthritis and Autoimmunity; E. DiCarlo, MD, Hospital for Special Surgery; R.W. Cummings, BA, Hospital for Special Surgery; L.T. Donlin, PhD, Hospital for Special Surgery; D.E. Orange, MD, Rockefeller University; A. Hoang, MD, Hospital for Special Surgery; S. Mirza, BA, Hospital for Special Surgery; M. McNamara, BA, Hospital for Special Surgery; K. Andersen, BA, Hospital for Special Surgery; S.J. Bartlett, PhD, departments of Clinical Epidemiology and Rheumatology, McGill University, and Department of Rheumatology, Johns Hopkins School of Medicine; J. Szymonifka, PhD, Department of Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Department of Orthopedics, Hospital for Special Surgery. goodmans@hss.edu.
3
From the Departments of Rheumatology and Orthopedics, Hospital for Special Surgery; Rockefeller University, New York, New York, USA; Mount Sinai Hospital, Rebecca McDonald Center for Arthritis and Autoimmunity, Toronto, Ontario; the departments of Clinical Epidemiology and Rheumatology, McGill University, Montreal, Quebec, Canada; the Department of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
4
S.M. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery; V.P. Bykerk, MD, Department of Rheumatology, Hospital for Special Surgery, and Mount Sinai Hospital, Rebecca McDonald Center for Arthritis and Autoimmunity; E. DiCarlo, MD, Hospital for Special Surgery; R.W. Cummings, BA, Hospital for Special Surgery; L.T. Donlin, PhD, Hospital for Special Surgery; D.E. Orange, MD, Rockefeller University; A. Hoang, MD, Hospital for Special Surgery; S. Mirza, BA, Hospital for Special Surgery; M. McNamara, BA, Hospital for Special Surgery; K. Andersen, BA, Hospital for Special Surgery; S.J. Bartlett, PhD, departments of Clinical Epidemiology and Rheumatology, McGill University, and Department of Rheumatology, Johns Hopkins School of Medicine; J. Szymonifka, PhD, Department of Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Department of Orthopedics, Hospital for Special Surgery.

Abstract

OBJECTIVE:

Rates of total knee arthroplasty (TKA) and total hip arthroplasty (THA) remain high for patients with rheumatoid arthritis (RA), who are at risk of flaring after surgery. We aimed to describe rates, characteristics, and risk factors of RA flare within 6 weeks of THA and TKA.

METHODS:

Patients with RA were recruited prior to elective THA and TKA surgery and prospectively followed. Clinicians evaluated RA clinical characteristics 0-2 weeks before and 6 weeks after surgery. Patients answered questions regarding disease activity including self-reported joint counts and flare status weekly for 6 weeks. Per standard of care, biologics were stopped before surgery, while glucocorticoids and methotrexate (MTX) were typically continued. Multivariable logistic regression was used to identify baseline characteristics associated with postsurgical RA flares.

RESULTS:

Of 120 patients, the mean age was 62 years and the median RA duration 14.8 years. Ninety-eight (82%) met 2010/1987 American College of Rheumatology/European League Against Rheumatism criteria, 53 (44%) underwent THA (and the rest TKA), and 61 (51%) were taking biologics. By 6 weeks, 75 (63%) had flared. At baseline, flarers had significantly higher disease activity (as measured by the 28-joint Disease Activity Score), erythrocyte sedimentation rate, C-reactive protein, and pain. Numerically more flarers used biologics, but stopping biologics did not predict flares, and continuing MTX was not protective. A higher baseline disease activity predicted flaring by 6 weeks (OR 2.12, p = 0.02).

CONCLUSION:

Flares are frequent in patients with RA undergoing arthroplasty. Higher baseline disease activity significantly increases the risk. Although more patients stopping biologics flared, this did not independently predict flaring. The effect of early postsurgery flares requires further study.

KEYWORDS:

POSTOPERATIVE FLARE; RHEUMATOID ARTHRITIS; RISK FACTORS; TOTAL HIP ARTHROPLASTY; TOTAL KNEE ARTHROPLASTY

PMID:
29545451
DOI:
10.3899/jrheum.170366

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