Rheumatoid arthritis patients gets pain relief by knee replacement

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Rheumatoid arthritis patients gets pain relief by knee replacement

According to the new study, the affected joint can be temporarily returned to an earlier, better level of function in rheumatoid arthritis (RA) patients by knee replacement surgery.

The senior author of the new study, Kaleb Michaud, Associate professor, Internal medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha said “The surgery” acts like a time machine for RA patients and is a very important treatment option. It has shown to improve patients’ life after surgery.

Majority of knee replacement surgery studies focuses on osteoarthritis (OA) patients, which involves the breakdown of cartilage while patients with autoimmune RA have painful inflammation and swelling of tissues around their joints. When arthritis strikes the knee, both forms get pain that a patient may prefer to replace their joints.

Big group of RA patients was included in this study (published online in Arthritis and Rheumatology) to inspect the pain levels and other factors related to quality of life of patients with knee replacement.

Patients who underwent total knee replacement surgery between 1999 and 2012 were looked for the information. 834 patients with RA and 315 with OA who had undergone the surgery at about the same age (mid-60s) were focused out of the total 19000 study patients. Patients responded to the questions about pain and function before surgery, immediately after surgery, and after six months and then compared those ratings across time points.

There was a tremendous decrease in pain and improved function after surgery, despite of type of arthritis. RA patients had fewer tender joints after procedure. According to Michaud, the study was unusual because large, separate group of RA patients was included while a lot of other studies look only at OA patients or groups mixed together. In expert opinion, both groups experienced less pain after healing but their recovery experience may differ after the surgery.

Michael Geelhoed, Director, Clinical education, Department of Physical Therapy, University of Texas Health Science Center, San Antonio believes that post-op recovery for RA is more complex than OA and RA patients should stop taking anti-rheumatic medications to reduce post-surgery infection risks because body's ability to fight infections is inhibited by these drugs. However, RA patients having knee surgery are usually younger, as age is another risk factor for complications. Knee replacement can cost around $20,000, although hospital charges can vary and can be covered by medicare.

Michaud also said that pain improvement and function would last for long, so total knee replacement was clear option for OA with replaced knee as only problem, while RA patients will experience painful joints and an eventual decline in replaced knee as their disease continue. These patients will observe a big difference but the same impact will not be there in long term as with OA.

Michaud considers total knee replacement as a major decision and a turning point for RA patients who choose this replacement after a lot of pain and suffering."

Arthritis and Rheumatology
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