Objectives: Despite marked progress in the medical treatment of rheumatoid arthritis (RA), some patients still require surgical reconstruction of damaged joints. To clarify the effect of wrist, hand and elbow surgeries, we evaluated patient reported outcomes using a Japanese version of the disability of the arm, shoulder and hand (DASH) questionnaire, in addition to our own original questionnaire.
Methods: We studied a prospective cohort of 70 patients who underwent upper extremity surgery. Surgical sites included elbows in 16 patients, wrists in 34 patients, and hands (thumb or fingers) in 32 patients, respectively. In 12 patients, wrist and hand surgeries were performed concurrently. Patients were evaluated by the DASH questionnaire and the disease activity score-28 using C-reactive protein (4) (DAS28-CRP (4)) at just prior to surgery, at 6 months and at one year after surgery. Postoperatively, original questionnaires were sent to the patients to try and ascertain the level of their satisfaction. The strength of the association between the original satisfaction score and each item of DASH was measured using the Spearman’s rank-order correlation test.
Results: The mean DASH score preoperatively was 47.3, which decreased to 40.8 (P<0.05) at 6 months and to 39.5 (P<0.01) at one year after surgery. The mean DAS28-CRP (4) score decreased from 3.3 to 2.4 (P<0.01) and then to 2.4 (P<0.01). Eighty-three percent of the patients completed our original questionnaire and 86% of them were “most satisfied” or “satisfied” with the surgically-treated site. The score of “27. Weakness in your arm, shoulder or hand.” had a negative correlation with their present condition, the usability of their hands, and their level of satisfaction.
Conclusion: The wrist, hand and elbow surgeries for patients with RA improved specific function of the surgically-treated site as well as disease activity. Power in the upper extremity without pain appeared to be the determinant of patient satisfaction.
