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 HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.