Kompendium 2020 Forschung & Klinik

More documents

Info

TOP-Studien 30 Rheumatoid Arthritis Disease Activity and the Risk of Aseptic Arthroplasty Loosening Rheumatoid arthritis (RA) is characterised by typical joint inflammation and synovitis, which, if not treated effectively, leads to joint destruction and functional disability. Although new treatment strategies improved long-term outcomes tremendously, rates of total hip and knee arthroplasty (THA/TKA) in patients with RA remain considerable. As RA differs fundamentally from osteoarthrosis (OA) in terms of prognosis, pathogenesis, and medical treatment, outcomes of total joint arthroplasty (TJA) and rates of complications would be expected to be different between these two diseases. Aseptic loosening is the most common cause for surgical revision after TJA with far-reaching implications, including an exchange of the implant associated with decreased function, loss of bone stock and an increased risk for further complications. Reasons for aseptic loosening are not fully understood, but local inflammation is suspected to play a crucial role. Systemic inflammation in RA might influence this process of local inflammatory-mediated osteolysis and could lead to higher aseptic loosening rates in RA patients, especially in those with increased inflammatory activity. The objective of this study was to assess the influence of RA disease activity on the risk of aseptic loosening after TJA. Furthermore, we evaluated if antirheumatic therapy has an influence on the risk of aseptic loosening. Additionally, we analysed the rates of radiographic aseptic loosening in OA patients, as a control group without systemic inflammation. Study: Böhler C, Weimann P, Alasti F, Smolen JS, Windhager R, Aletaha D. Rheumatoid arthritis disease activity and the risk of aseptic arthroplasty loosening. Semin Arthritis Rheum. <strong>2020</strong> Apr; 50(2):245–251 Patients and Methods We ascertained data of 49 RA patients who underwent primary TJA with a fully documented disease activity as well as a complete clinical and radiological follow-up for analysis. Further we investigated a cohort of OA patient, who were matched 2:1 for sex, age, date of surgery, and location of TJA as a control group without systemic inflammation. We obtained demographic data, comorbidities, antirheumatic therapy results, clinical and functional scores, duration of surgery, and the type of implant. Due to the restricted number of revision surgery because of aseptic loosening, we used radiological signs of component loosening (RCL) as a more sensitive surrogate outcome parameter for our main analysis. These included radiolucent lines (RLL) with a width of ≥2mm, osteolysis exceeding 2mm in thickness, and implant migration of ≥2mm. Two independent observers, who were blinded for levels of disease ac-
TOP-Studien 31 Aseptic loosening is the most common cause for surgical revision after TJA with far-reaching implications. „Inflammation in RA patients, as evidenced by higher levels of disease activity, increases the risk for radiographic loosening after TJA. In OA patients, as a control disease without systemic inflammation, the risk is significantly lower.“ Christoph Böhler tivity and the clinical diagnosis (OA/RA), evaluated the radiographs. Patients were seen after 6 weeks, 3 and 12 months, and then annually after the TJA. The Simplified Disease Activity Index (SDAI) was used to determine disease activity levels. At our rheumatology outpatient clinic, RA patients are followed every 3 months, and their clinical and laboratory variables are documented prospectively in an observational database. For statistical analysis we performed Cox regression to estimate RCL based on SDAI, adjusting for the anti-rheumatic therapy (conventional vs. biological disease modifying drugs, DMARDs). Furthermore, we compared the rates of aseptic loosening and RCL in RA and OA patients using the Chi-Square-Test, the Kaplan Meier method, and applied the Log-Rank test to statistically compare survival distributions. Results 32 patients (65.3%) underwent TKA, and 17 (34.7%) THA. All TKA were cemented and all THA were fixated cementless. In total 18 (36.7%) showed signs of RCL. Time integrated SDAI was significantly higher in patients with RCL (median; 25th and 75th percentile: 10.8; 8.6 and 15.8) than in controls without RCL (7.0; 2.7 and 15.5) (Figure 1; p=0.043). When comparing RCL across patient groups in different RA disease activity states, we found that in the remission group no patient showed signs of RCL (0/10), whereas in the low and moderate/high disease activity groups 10/21 (47.6%) and 8/17 (47.1%) patients, respectively, showed signs of RCL (p=0.023). RA patients receiving biologicals had clearly lower rates of RCL (4/18; 22.2%) compared to RA patients under traditional DMARD therapy (14/28; 50%). In logistic regression analyses biologicals significantly reduced the risk of RCL with an odds ratio (OR) of 0.192 (95% CI 0.042-0.891; p=0.035). The RCL rate was 36.7% in the RA group and 13.6% in the OA group (p=0.002). This was mainly explained by a higher rate of RCL in the TKA group (RA: 34.4%; OA: 6.5%; p=0.001), while the rates in the THA group were only numerically higher in patients with RA compared to OA (41.2% vs. 30.8%, respectively; p=0.528). Discussion The current study for the first time links the risk of aseptic loosening in RA patients to the level of inflammation with higher disease activity being associated with more frequent occurrence of radiographic loosening. Biological
Page 1 and 2: Kompendium 2020 Forschung & Klinik
Page 3 and 4: Inhalt/Impressum 3 Die Klinik 4 Edi
Page 6 and 7: Zahlen und Fakten 6 Klinische Leist
Page 9 and 10: Zahlen und Fakten 9 Hohe Ambulanzfr
Page 11 and 12: Klinik 11 Neben der Polytrauma-Vers
Page 13 and 14: Die Meniskusversorgung Alle Möglic
Page 15 and 16: Das ÄrztInnenteam 15 Universitäts
Page 17 and 18: Spherox ist das einzig EMA-zugelass
Page 19 and 20: Das ÄrztInnenteam 19 Medizinische
Page 21 and 22: Ambulanzen 21 Spezialambulanzen Kli
Page 23 and 24: TOP-Studien 23 defects (≤ Interna
Page 25 and 26: WE LENGTHEN, TRANSPORT AND GROW BON
Page 27 and 28: TOP-Studien 27 5 5 Patients (-) 10
Page 29: FRESH AIR FRESH PERSPECTIVE Remove
Page 33 and 34: Integriertes Patientenversorgungsko
Page 35 and 36: TOP-Studien 35 Figure 1: Bone miner
Page 37 and 38: TOP-Studien 37 A Prediction Model f
Page 39 and 40: TOP-Studien 39 Figure 2: Graphic vi
Page 41 and 42: TOP-Studien 41 Figure 1: Individual
Page 43 and 44: 3D Biochips for Research on Inflamm
Page 45 and 46: TOP-Studien 45 Chondro-Synovial Cro
Page 47 and 48: TOP-Studien 47 Figure 1. (A) Intrao
Page 49 and 50: TOP-Studien 49 Total Hip Arthroplas
Page 51 and 52: TOP-Studien 51 nerve lesions (1 N.
Page 53 and 54: TOP-Studien 53 1 Volume fill of car
Page 55 and 56: TOP-Studien The Genetic Landscape o
Page 57 and 58: TOP-Studien 57 rare heterozygous lo
Page 59 and 60: TOP-Studien 59 Figure 1: Example of
Page 61 and 62: COPAL ® - ERFOLGREICH GEGEN INFEKT
Page 63 and 64: TOP-Studien 63 Figure 1: Biomechani
Page 65 and 66: TOP-Studien 65 Development of a New
Page 67 and 68: TOP-Studien 67 Table 1: Relative ro
Page 69 and 70: Publikationen 69 Bumberger A, Kolle
Page 71 and 72: Publikationen 71 sou NA, McNally MA
Page 73 and 74: Publikationen 73 Propensity-Matched
Page 75 and 76: Publikationen 75 novel hypothetical
Page 77 and 78: Publikationen 77 ritisches Denken.
Page 79 and 80: Publikationen 79 Zuteilungsdatum: 2
Page 81 and 82:
Publikationen 81 Payr S: Reviewer J
Page 83 and 84:
Publikationen 83 fracture, Wrist Ar
Page 85 and 86:
Kundenkompetenzzentrum mit Shop & W
Page 87:
·
show all

Kompendium 2020 Forschung & Klinik

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?