New York, NY—November 14, 2016
A flare up of symptoms in patients with rheumatoid arthritis (RA) who undergo major joint replacement is extremely common right after surgery. This may be due to the fact that medication regimens are often altered or discontinued before and after surgery to lower infection risk.
A new study by researchers from Hospital for Special Surgery in New York City reports that though these flares in RA are of course unpleasant to patients, they may not actually worsen patient pain and functioning one year out from surgery.
The findings - which were presented at the American College of Rheumatology Annual Meeting in Washington, DC - could have major implications for how RA patient medications are managed around the time of joint replacement surgery.
In the study, 100 patients with RA who underwent total hip or total knee replacement were administered the RA Flare Questionnaire weekly for six weeks. Flares were defined by a concordance between patients reporting that they were indeed having a flare and physician assessment of patient-reported symptoms. Pain and function were assessed at baseline before surgery and one year later using scores on the HOOS and KOOS, two commonly used questionnaires that grade hip and knee function, respectively.
With one-year results now available on 40 patients enrolled in the study, there appears to be no statistically or clinically significant difference in pain and function one year after surgery.
"Our findings are especially encouraging," explains study lead author Susan M. Goodman, MD, rheumatologist at HSS. "Upwards of 65% of RA patients experience a flare following joint replacement, and we’re always trying to adjust medications the best we can since we’re worried about infection."
Based on the new results, Goodman feels that perhaps rheumatologists don’t need to worry as much about tinkering with medications around the time of joint replacement surgery, but cautions that the results need to be confirmed in the remaining study patients.
Moreover, other research that Goodman is involved with has found that the main priority for RA patients undergoing joint replacement is avoiding infection, even if it means putting up with a flare.
Goodman notes that given the small sample size, more research is necessary to confirm their findings. However, her group plans to have data available on the remaining 60 patients in the study in the near future.
"This is the first study of its kind, and one that can help make our lives easier while also putting patients at ease," she says. "We’re all very excited."
About Hospital for Special Surgery
Hospital for Special Surgery (HSS) is the world’s leading academic medical center focused on musculoskeletal health. HSS is nationally ranked No. 1 in orthopedics and No. 2 in rheumatology by U.S. News & World Report (2016-2017), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. HSS has one of the lowest infection rates in the country. HSS is an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.