Objective: Most patients with rheumatoid arthritis (RA) have the joint damage in their wrists and fingers, but joint destruction in the large joints has a severe influence on the activities of daily living (ADL). We therefore scored almost normal joints including the bilateral shoulders, elbows, hips, knees, ankles and the neck based on a point system, with the maximum possible score being 12 points (Neck Large Joint (NLJ) Score 12). As the progressive group 102 RA patients treated with 153 total knee arthroplasties (TKAs-TKA group) were followed up for 5 to 15 years. As the control group 104 early RA patients followed up for 10 to 20 years were selected.
Methods: We evaluated the functional scores for the Japanese Orthopaedic Association (JOA Score), Neck Large Joint Score 12 (NLJ Score 12), Disease Activity Score (DAS) 28 and the RA class.
Results: The JOA score was 42 points at operation, 81 at 5 years and 72 at 10 years. The NLJ score 12 was 8.8 at 5 years, 7.3 at 10, 6.7 at 15, 5.8 at 20, 4.2 at 25 and 3.3 at 30 years. DAS 28 did not correlate with the JOA score and NLJ Score12. In the TKA group the destruction of four large joints had occurred at five years from onset and that of one large joint in the next five years. On the other hand in the early RA group with conventional DMARDs therapy, destruction of one large joint occurred every five years.
Conclusion: RA patients treated with TKA were the progressive group, because the destruction of four large joints in the RA TKA group occurred during the first five years from onset.
