生物学的製剤使用下に人工膝関節全置換術を施行した関節リウマチ患者の疾患活動性と関節破壊進行の関連性

抄録

Objective: The aim of the present study was to investigate the association between disease activity of rheumatoid arthritis (RA) and radiographic progression in patients using biological agents and undergoing total knee arthroplasty (TKA).

Methods: The study population included 40 patients (5 men, 35 women) with RA who were being treated with biological agents and who were scheduled to undergo TKA. Biologic agents had been initiated at our hospital after performing joint X-ray examinations. The mean age was 60.7 years and the mean duration of disease was 13.8 years. We evaluated the disease activity of RA using the 28-joint Disease Activity Score with C-reactive protein (DSA28) and radiographs using the Larsen grade at the time of initiation of biologic agents, and at the time of TKA. Clinical response at surgery was defined according to the European League Against Rheumatism (EULAR) response criteria based on the DAS28.

Results: From the time of initiating biological agents to the time of undergoing TKA, the mean DAS28 score decreased significantly from 4.60 to 3.45. According to the EULAR response criteria, good responses were seen in 14 patients, moderate responses were seen in 15 patients, and no responses were seen in 11 patients, respectively. Thirty-two knee joints were grade Ⅰ/Ⅱ at the initiation of biological agents, but 25 of 32 knee joints showed more than two grades of progression on the Larsen grade at the time of TKA. The good response group indicated 1.57 grades of progression on the Larsen scale, while the no response group showed 2.10 grades of progression on the scale.

Conclusion: Grade Ⅰ/Ⅱ pre-existing damage from RA showed progression even in patients treated with biological agents. These results show that poorer response to biological treatment is associated with more progressive radiographic changes.