title: Systemic effects of surgical intervention on disease activity, daily function, and medication in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  Although tight control of rheumatoid arthritis (RA) has been achieved through the development of effective medication, surgical intervention is still required for a certain subpopulation of patients. To examine the systemic effects of orthopaedic surgery, we evaluated improvements in disease activity, daily function, and medication after surgery.
  
  
  METHODS
  A prospective cohort study was conducted in 196 cases of elective orthopaedic surgery in 150 patients with RA from January 2011 to March 2014 in our institution. The 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR) and modified Health Assessment Questionnaire (mHAQ) scores just before surgery and at 6 and 12 months after surgery were examined prospectively. Concomitant medications were also investigated.
  
  
  RESULTS
  Significant improvement was seen in the DAS28-ESR and mHAQ scores for replacement surgery in both the upper and lower extremities, and for arthroplasty/arthrodesis in the upper extremities at the 12-month follow-up. Partial mHAQ scores for the lower extremities were significantly reduced in lower replacement surgery, and partial mHAQ scores for the upper extremities were significantly reduced in upper arthroplasty/arthrodesis surgery. Although the use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) did not decrease after surgery, the dose of prednisolone (PSL) decreased significantly at 12 months after surgery, especially in the well-controlled group and in surgical procedures in the lower extremities.
  
  
  CONCLUSIONS
  Elective orthopaedic surgery improves both systemic disease activity and general functional impairment. Orthopaedic surgery is effective in reducing the amount of medication required postoperatively.
authors: a Department of Orthopaedic Surgery , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: T
authors: T
authors: Iwata
authors: a Department of Orthopaedic Surgery , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: H
authors: H
authors: Ito
authors: a Department of Orthopaedic Surgery , Kyoto University Graduate School of Medicine , Kyoto , Japan.|b Department of Control for Rheumatic Diseases , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: M
authors: M
authors: Furu
authors: b Department of Control for Rheumatic Diseases , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: M
authors: M
authors: Hashimoto
authors: b Department of Control for Rheumatic Diseases , Kyoto University Graduate School of Medicine , Kyoto , Japan.|c Department of Rheumatology and Clinical Immunology , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: T
authors: T
authors: Fujii
authors: a Department of Orthopaedic Surgery , Kyoto University Graduate School of Medicine , Kyoto , Japan.|b Department of Control for Rheumatic Diseases , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: M
authors: M
authors: Ishikawa
authors: a Department of Orthopaedic Surgery , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: M
authors: M
authors: Azukizawa
authors: a Department of Orthopaedic Surgery , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: Y
authors: Y
authors: Hamamoto
authors: c Department of Rheumatology and Clinical Immunology , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: T
authors: T
authors: Mimori
authors: d Department of Orthopaedic Surgery , Gifu University Graduate School of Medicine , Gifu , Japan.
authors: H
authors: H
authors: Akiyama
authors: a Department of Orthopaedic Surgery , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: S
authors: S
authors: Matsuda
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis; D001178:Arthroplasty; D050806:Arthroplasty, Replacement, Finger; D001799:Blood Sedimentation; D015331:Cohort Studies; D005260:Female; D033023:Foot Joints / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D050823:Hand Joints / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D013131:Spine / Q000601:surgery; D011795:Surveys and Questionnaires; D000074402:Synovectomy; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D011239:Prednisolone