Total elbow replacement with the Souter-Strathclyde prosthesis in rheumatoid arthritis: long-term follow-up

INTRODUCTION Semiconstrained total elbow replacement is now a well recognised and reliable surgical option for advanced elbow disease, mainly rheumatoid arthritis. METHODS We report a retrospective analysis of 31 primary total elbow replacements in 28 patients with a mean follow-up duration of 55 months. The mean age of the patients was 65 years. The indications included 27 cases of rheumatoid arthritis, 3 fractures and 1 case of osteoarthritis. Twenty-one elbows in nineteen patients were assessed using the Mayo elbow performance score (MEPS) in a special follow-up clinic. In the other nine patients (ten elbows), the assessment was carried out with case notes and x-rays. RESULTS The mean pre-operative MEPS in the 21 elbows recalled was 40. This improved to 89 post-operatively (range: 55-100). Sixteen of the twenty-one elbows were considered excellent, two good, two fair and one poor. The range of movement was recorded in eight of the other ten elbows and the mean was 98°. At the last follow-up visit, x-rays were normal in 23 elbows although the ulnar component was loose in 3, the humeral component loose in 2. There were also two cases of nonunion of the medial epicondyle and one patient had mild heterotopic ossification. Complications included one infection, which needed irrigation and debridement with a satisfactory final result, and two cases of ulnar nerve palsy/neurapraxia. Two elbows were considered failures due to severe pain caused by prosthetic loosening. These were referred for revision surgery. CONCLUSIONS Excellent pain relief and good function can be achieved in the medium and long term with the Coonrad-Morrey semiconstrained total elbow replacement prosthesis in patients with severe destructive elbow arthropathy.

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THU0015 The Impact of Biologic Therapies on CD4+ and CD8+ Cell Subsets in Rheumatoid Arthritis: A Long Term Follow-Up Study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-eular.2525 ◽

2016 ◽

Vol 75 (Suppl 2) ◽

pp. 182.3-183

Author(s):

S. Dulic ◽

G. Toldi ◽

Z. Vásárhelyi ◽

A. Balog

Keyword(s):

Rheumatoid Arthritis ◽

Biologic Therapies ◽

Follow Up Study ◽

Long Term Follow Up ◽

Cd8 Cell ◽

The Impact

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Understanding the Mechanisms of Pain in Rheumatoid Arthritis

Rheumatoid Arthritis - Other Perspectives towards a Better Practice ◽

10.5772/intechopen.93829 ◽

2020 ◽

Author(s):

Kathryn Biddle ◽

Nidhi Sofat

Keyword(s):

Rheumatoid Arthritis ◽

Joint Damage ◽

Joint Inflammation ◽

Long Term Follow Up ◽

Important Symptom ◽

Ongoing Pain ◽

Disease Modifying Agents

Pain is a debilitating feature of rheumatoid arthritis (RA) and is often described by patients as their most important symptom. Rheumatoid arthritis pain has traditionally been attributed solely to joint inflammation, however despite the advent of increasingly effective disease modifying agents, patients continue to report pain at long term follow up. The cause for ongoing pain is multifactorial and includes joint damage and pain sensitisation. In this book chapter, we will describe the mechanisms underlying the distinct components of pain which are manifest in rheumatoid arthritis and discuss why a thorough assessment of pain is vital to target treatments appropriately.

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Does immunological remission, defined as disappearance of autoantibodies, occur with current treatment strategies? A long-term follow-up study in rheumatoid arthritis patients who achieved sustained DMARD-free status

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2018-214868 ◽

2019 ◽

Vol 78 (11) ◽

pp. 1497-1504 ◽

Cited By ~ 3

Author(s):

Debbie M Boeters ◽

Leonie E Burgers ◽

René EM Toes ◽

Annette van der Helm-van Mil

Keyword(s):

Rheumatoid Arthritis ◽

Treatment Strategies ◽

Signs And Symptoms ◽

Current Treatment ◽

Dmard Therapy ◽

Before And After ◽

Long Term Follow Up ◽

Free Status

ObjectivesSustained disease-modifying antirheumatic drug (DMARD)-free status, the sustained absence of synovitis after cessation of DMARD therapy, is infrequent in autoantibody-positive rheumatoid arthritis (RA), but approximates cure (ie, disappearance of signs and symptoms). It was recently suggested that immunological remission, defined as disappearance of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF), underlies this outcome. Therefore, this long-term observational study determined if autoantibodies disappear in RA patients who achieved sustained DMARD-free remission.MethodsWe studied 95 ACPA-positive and/or RF-positive RA patients who achieved DMARD-free remission after median 4.8 years and kept this status for the remaining follow-up (median 4.2 years). Additionally, 21 autoantibody-positive RA patients with a late flare, defined as recurrence of clinical synovitis after a DMARD-free status of ≥1 year, and 45 autoantibody-positive RA patients who were unable to stop DMARD therapy (during median 10 years) were studied. Anti-cyclic citrullinated peptide 2 (anti-CCP2) IgG, IgM and RF IgM levels were measured in 587 samples obtained at diagnosis, before and after achieving DMARD-free remission.Results13% of anti-CCP2 IgG-positive RA patients had seroreverted when achieving remission. In RA patients with a flare and persistent disease this was 8% and 6%, respectively (p=0.63). For anti-CCP2 IgM and RF IgM, similar results were observed. Evaluating the estimated slope of serially measured levels revealed that RF levels decreased more in patients with than without remission (p<0.001); the course of anti-CCP2 levels was not different (p=0.66).ConclusionsSustained DMARD-free status in autoantibody-positive RA was not paralleled by an increased frequency of reversion to autoantibody negativity. This form of immunological remission may therefore not be a treatment target in patients with classified RA.

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Coronary Artery Calcification Is Related to Inflammation in Rheumatoid Arthritis: A Long-Term Follow-Up Study

BioMed Research International ◽

10.1155/2016/1261582 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Bengt Wahlin ◽

Thomas Meedt ◽

Fredrik Jonsson ◽

Michael Y. Henein ◽

Solveig Wållberg-Jonsson

Keyword(s):

Rheumatoid Arthritis ◽

Coronary Artery ◽

Coronary Artery Calcification ◽

Intima Media Thickness ◽

Projection To Latent Structures ◽

Follow Up Study ◽

Long Term Follow Up ◽

Latent Structures

Objective. A long-term follow-up of patients with rheumatoid arthritis (RA) to evaluate factors related to coronary artery calcification (CAC).Methods. All 22 eligible patients (4 males/18 females, mean age 65 years, and RA-duration 30–36 years) from the original (baseline;n=39) study of atherosclerosis were included. Inflammation, cardiovascular risk factors, and biomarkers were measured at baseline. At follow-up 13 years later, CAC was assessed by computed tomography (CT) and the grade of inflammation was measured. Multivariate analysis of differences between patients with low (0–10) and high CAC (>10) was done by orthogonal projection to latent structures (OPLS).Results. Ten patients had CAC 0–10 and 12 had >10 (range 18–1700). Patients with high CAC had significantly higher ESR (24.3 versus 9.9 mm/h) and swollen joint count (2 versus 0). The OPLS models discriminated between patients having high or low CAC. With only baseline variables, the sensitivity was 73% and the specificity 82%. The model that also included inflammatory variables from follow-up had a sensitivity of 89% and a specificity of 85%. Exclusion of baseline intima media thickness and plaque from the latter model modestly reduced the accuracy (sensitivity 80% and specificity 83%).Conclusions. CAC is related to inflammation in patients with RA.

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