Improving Depression by Joint Surgery in Established Rheumatoid Arthritis; Results from Multicenter Prospective Cohort Study for Evaluation of Joint Surgery on Patient’s Reported Outcome

Toshihisa Kojima¹, Masayo Kojima ², Hajime Ishikawa ³, Sakae Tanaka ⁴, Nobuhiko Haga ⁵, Keiichiro Nishida ⁶, Masao Yukioka ⁷, Jun Hashimoto ⁸, Hisaaki Miyahara ⁹, Yasuo Niki ¹⁰, Tomoatsu Kimura ¹¹, Hiromi Oda ¹², Shuji Asai ¹, Koji Funahashi ¹³ and Naoki Ishiguro ¹, ¹Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan, ²Nagoya City University Graduate School of Medicne, Nagoya, Japan, ³Niigata Rheumatic Center, Niigata, Japan, ⁴University of Tokyo, Tokyo, Japan, ⁵The University of Tokyo Hospital, Tokyo, Japan, ⁶Okayama University, Graduate School of Medicine, Okayama, Japan, ⁷Yukioka Hospital, Osaka, Japan, ⁸National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan, ⁹National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan, ¹⁰Keio University, School of Medicine, Tokyo, Japan, ¹¹University of Toyama, Faculty of Medicine, Toyama, Japan, ¹²Department of Orthopedic Surgery, Faculty of Medicine, Saitama Medical University, Saitama, Japan, ¹³Kariya-Toyota General Hosptal, Kariya, Japan

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Orthopedics, patient-reported outcome measures and depression, rheumatoid arthritis, treatment

Session Information

Date: Tuesday, November 12, 2019

Title: RA – Treatments Poster III: Safety and Outcomes

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Total management including reconstructive joint surgery and rehabilitation should be needed for further improvements of physical function for long-standing RA patients. In these days, it is very important to evaluate the effectiveness of joint surgery as well as drug therapy based on patient-reported outcome (PRO) The purpose of this study is to explore the relationship among depression, clinical variables and other PROs including physical function.

Methods: Multicenter prospective observational cohort study was conducted among patients who underwent elective joint surgery for RA from April 2012 to March 2016 (Study registration: UMIN000012649). In this study, we collected data at baseline and at 6 or 12 months after the surgery. These data were as follow; age, sex, disease duration, drug therapies, and disease activity (DAS), TUG, and patient-reported outcome [HAQ-DI, EQ-5D (QOL), pain and BDI-II (depression)]. Correlation between BDI-II and other variables were determined using multiple liner regression analysis.

Results: Totally, 346 patients before elective joint surgery were analyzed cross-sectionally. Mean age, disease duration, pain(VAS), DAS28, HAQ-DI, EQ-5D and BDI-II were 64.2 years, 17.0 years, 36.2 mm, 3.02, 1.11, 0.641 and 13.0, respectively. 52.6% of elective joint surgeries were in upper limbs and 47.4% were in lower limbs. Multiple liner regression analysis showed that HAQ-DI [B:-0.099 (95%CI:-0.117- -0.08) β:-0.48] pain VAS [B:-0.002 (95%CI:-0.002- -0.001) β:-0.26] and BDI-II [B:-0.003 (95%CI:-0.005- -0.002) β:-0.19] were independent factors for EQ-5D. Furthermore, HAQ-DI [B:3.78 (95%CI:2.54- 5.06) β: 0.33] and pain VAS [B: 0.062 (95%CI: 0.023- 0.101) β 0.17] were significant impact on BDI-II. Especially, walking and eating were independent factors for BDI-II in HAQ-DI categories.

We confirmed these BDI-relating factors above in longitudinal analyses, at last observation (6 or 12 months) after joint surgery in lower limbs (n=138). BDI-II was remarkably improved from 12.1 (mean) to 10.5. Change in HAQ-DI had significant impact on that in BDI-II [B:3.183 (95%CI:0.301- 6.065) β:0.229] while that in painVAS did not. The improving in walking was a relevant factor for improving of BDI-II after the surgery [B:2.898(95%CI:0.641- 5.155) β:0.213].

Conclusion: Depression is an important patient-reported outcome for QOL in established RA patients. Improving of physical function with joint surgery in lower limbs caused improving of depression status. Rheumatologists should take the joint surgery into consideration as effective intervention for treatment of established RA patients.

Disclosure: T. Kojima, AbbVie, 2, 8, Abbvie, 8, Astellas, 2, 8, Bristol-Myers Squibb, 2, 8, Chugai, 2, 8, Chugai Pahrmaceutical, 2, 8, Chugai Pharmaceutical CO., LTD., 2, 8, Daiichi-Sankyo, 2, 8, Eli Lilly, 2, 8, Janssen, 2, 8, Janssen Pharmaceutical, 8, Lilly, 2, 8, Mitsubishi Tanabe, 2, 8, Novartis, 2, 8, Pfizer, 2, 8, Takeda, 2, 8, Tanabe Mitsubishi Pharma, 8; M. Kojima, None; H. Ishikawa, None; S. Tanaka, Astellas Pharma, Inc., 2, 5, 8, 9; N. Haga, None; K. Nishida, None; M. Yukioka, None; J. Hashimoto, None; H. Miyahara, None; Y. Niki, None; T. Kimura, None; H. Oda, None; S. Asai, AbbVie, 8, Abbvie, 8, Astellas, 8, Bristol-Myers Squibb, 8, Chugai, 8, Chugai Pahrmaceutical, 8, Chugai Pharmaceutical CO.,LTD., 8, Daiichi-Sankyo, 8, Eisai, 8, Janssen, 8, Janssen Pharmaceutical, 8, Pfizer, 8, Takeda, 8, Tanabe Mitsubishi Pharma, 8, UCB Japan, 8; K. Funahashi, None; N. Ishiguro, AbbVie, 2, 8, Abbvie, 2, 8, Asahi Kasei, 2, 8, Astellas, 2, 8, Astellas Pharma, 2, 8, Bristol-Myers Squibb, 2, 8, Chugai, 2, 8, Chugai Pahrmaceutical, 2, 8, Chugai Pharmaceutical CO.,LTD., 2, 8, Daiichi-Sankyo, 2, 8, Eisai, 2, 8, Eli Lilly, 2, 8, Janssen Pharmaceutical, 8, Kaken, 2, 8, Lilly, 8, Medical Corporation Sanjinkai, 2, 5, 8, Medical Corporation Toukoukai, 2, 5, 8, Mitsubishi Tanabe, 2, 8, Ono, 2, 8, Otsuka, 2, 8, Pfizer, 2, 8, Taisho Toyama, 2, 8, Takeda, 2, 8, Tanabe Mitsubishi Pharma, 2, 8, UCB, 8, Zimmer Biomet, 2, 8.

To cite this abstract in AMA style:

Kojima T, Kojima M, Ishikawa H, Tanaka S, Haga N, Nishida K, Yukioka M, Hashimoto J, Miyahara H, Niki Y, Kimura T, Oda H, Asai S, Funahashi K, Ishiguro N. Improving Depression by Joint Surgery in Established Rheumatoid Arthritis; Results from Multicenter Prospective Cohort Study for Evaluation of Joint Surgery on Patient’s Reported Outcome [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/improving-depression-by-joint-surgery-in-established-rheumatoid-arthritis-results-from-multicenter-prospective-cohort-study-for-evaluation-of-joint-surgery-on-patients-reported-outcome/. Accessed .

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