Влияние терапии ревматоидного артрита на результаты артропластики крупных суставов (предварительное сообщение)

Purpose: to evaluate the results of the knee and hip arthroplasty in patients with rheumatoid arthritis (RA) depending on baseline disease activity and received drug therapy. Materials and methods. Arthroplasty was performed in 48 patients (hip - 39 and knee - 9) with RA. The mean age was 49.5±15.82 years. Disease activity according to DAS28 - 4.41±1.83. All the patients received NSAIDs in stable doses. 26 (54.2%) patients received corticosteroids at a dose of 5-10 mg/day in terms of prednisolone, and 30 (62.5%) -basic antirheumatic drugs (DMARDs). Treatment was ongoing at the time of surgery and 6 months or more after it. Assessment of pain (VAS), disease activity (DAS28), quality of life (HAQ) were evaluated preoperatively, before discharge from hospital and 6 months after. Results. The pain (VAS) decreased by 34.2±19.1 mm in patients who received DMARDs and HAQ by 0.70±0.32 (p<0.05) compared with patients treated with corticosteroids without basic therapy (AVAS 24.2±18.2 mm, AHAQ = 0.46±0.31). Postoperative complications such as deep vein thrombosis and soft tissue infections are more likely in patients receiving steroid therapy. Conclusion. Arthroplasty is an effective method in improving the functional status, pain relief and it helps to reduce the rheumatoid arthritis activity. Surgery results in relation to the life were better in patients taking DMARDs. Steroids undoubtedly increase the risk of complications and decrease effectiveness of arthroplasty. It was recommended to reduce steroids dose during preparation of patient for surgery.