Background/Purpose: Disease activity dramatically ameliorated with the use of bDMARD or a recently appeared tsDMARD and more than one-half of the patients with RA were in remission. However, some patients were still difficult to achieve remission due to comorbidities, aging and economic burden of drug cost. Therefore, still some patients needed to undergo surgical reconstruction for the structurally damaged joint due to RA. The purpose of this prospective cohort study was to clarify the effect of surgical intervention to the upper extremity from the aspect of QOL and mental health as well as physical function.

Methods: From December 2012 to September 2014, a primary surgery was scheduled in 150 patients (male:20, female:130) with RA. The mean age was 64 years old, and the mean duration of RA was 16 years. Steinbrocker’s stage IV and class 2 were most frequent. The surgical site was 6 shoulders, 26 elbows, 73 wrists and 45 fingers or thumbs. There were 26 synovectomies, 39 arthroplasties without implant, 31 arthrodeses, and 54 joint replacements. EuroQol 5 dimension (EQ-5D), Beck Depression Inventory II (BDI-II), Japanese version of the Stanford Health Assessment Questionnaire (J-HAQ), and Disabilities of the Arm, Shoulder and Hand (DASH) were investigated just before the operation (baseline), and at 6 and 12 months after the operation.

Results: As a whole, EQ-5D improved from 0.708 at baseline to 0.747 (p<0.001) and 0.756 (p<0.001) at 6 and 12 months after the operation. Significant improvement in EQ-5D was noted in the elbow or the wrist surgeries, and all procedures other than synovectomy. BDI-II decreased from 13.8 at baseline to 12.3 (p=0.004) and 12.2 (p=0.001) at 6 and 12 months after the operation. At baseline, the patient was on the borderline of mild depression (between 14 and 19) and after the operation the patient was in minimal depression (between 0-13). Significant decrease in BDI-II was noted in the elbow or the wrist surgeries, and joint replacement. J-HAQ improved from 1.11 at baseline to 1.01 (p=0.008) and 0.95 (p<0.001) at 6 and 12 months after the operation. Significant improvement in J-HAQ was noted in the elbow or the wrist surgeries, and arthroplasty without implant and arthrodesis. DASH score decreased from 43.8 at baseline to 37.4 (p<0.001) and 36.3 (p<0.001) at 6 and 12 months after the operation. Significant decrease in DASH score was noted in the elbow or the wrist surgeries, and all surgical procedures.

Conclusion:  The surgical intervention to the upper extremity in the patient with RA improved QOL and mental health as well as physical function. It made the disabled patient happy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-surgical-intervention-to-the-upper-extremity-make-the-patients-with-rheumatoid-arthritis-happy/