Clinical Characteristics Of Joint Replacement With Rheumatoid Arthritis

Objective To investigate the clinical characteristics of RA patients undergoing joint replacement.Methods The 99 patients diagnosed with RA and joint replacement surgery in Ningxia Media Hospital from January 2012 to December 2019 were screened,and 233patients who were hospitalized at the same time and were diagnosed with RA and did not undergo joint replacement were selected at equal intervals,according to whether joint replacement was performed or not.Surgery was divided into surgical group and non-surgical group.The general conditions,clinical indicators,laboratory examinations,immunological indicators,imaging data and treatment conditions of the patients were collected respectively.Two independent samplet test,chi-square test,non-parametric test,logistic regression analysis were used.Results1.General information:99 patients in the surgical group and 233 patients in the non-surgical group.Compared with patients in the non-surgical group,the patients in the surgical group are older(t=6.428,P=0.000),and the number of smoking patients is small(X~2=5.707,P=0.017),the disease course is longer(Z=-10.343,P=0.000),and the BMI is higher(Z=-7.263,P=0.002).2.The situation of joint replacement in the operation group:(1)Joint replacement:knee joint and hip joint were the main replacement sites in the 99 patients with RA.There were 66cases(66.7%)who underwent knee joint replacement,61 cases of single knee joint and 5cases of double knee joint.Thirty-three patients(33.3%)underwent hip arthroplasty,all of which were single hip joint.(2)Joint replacement rate in different years:The rate of RA joint replacement from 2012 to 2019 was 1.7%in 2012,1.4%in 2013,1.1%in 2014,1.0%in 2015,0.4%in 2016,0.8%in 2017,0.7%in 2018,and 0.6%in 2019,respectively,showing a general downward trend.3.Clinical manifestations:Compared with patients in the non-surgical group,the patients in the surgical group have longer morning stiffness(Z=-3.187,P=0.001),more joint deformities(X~2=25.937,P=0.000),and joints are first affected at onset There are more patients with large joints(X~2=42.276,P=0.000),and extra-articular manifestations are more likely to occur(X~2=96.586,P=0.000).4.Laboratory indicators:Compared with patients in the non-surgical group,the ALP of the surgical group was higher(Z=-4.763,P=0.000),the two groups of WBC,PLT,HGB,PTA,INR,APTT,FIB,TT,DD aggregates There was no statistically significant difference in quantification,Cr,AST,ALT,LDH,CRP,ESR(P>0.05).5.Rhiumatism immune indexes:Compared with patients in the non-surgical group,the positive rates of Ig M,RF and anti-CCP antibodies in the surgical group were lower(Z=-2.604,P=0.009,X~2=14.384,P=0.000,X~2=19.876,P=0.000),the positive rate of AKA was relatively high(X~2=5.211,P=0.022);there was no significant difference in immunological indicators such as complement C3,complement C4,Ig A,Ig G,anti-ENA antibody,and anti-ANA antibody between the two groups of patients(P>0.05).6.Disease activity:Compared with patients in the non-surgical group,the DAS28 score in the surgical group was lower(Z=-5.527,P=0.000),and the moderate activity of DAS28 in the surgical group was higher than that in the non-surgical group(X~2=16.453,P=0.000).The high activity of DAS28 in group was lower than that in non-surgical group(X~2=18.265,P=0.000).7.X-ray examination:Compared with the non-surgical group,the patients in the surgery group were mainly in stage III(Z=-15.090,P=0.000).8.Risk factor analysis:Risk factors were screened by Logistic regression analysis,and age,course of disease and body mass index were the risk factors for RA patients to undergo joint replacement surgery.9.Treatment:In the operation group,patients with a history of use of biological agents or hormones did not have postoperative infection.10.Prognosis:All 99 patients undergoing joint replacement were included in the follow-up.Among them,21 were lost to follow-up and 3 died.A total of 75 patients were evaluated.The average follow-up time was 4.54±1.76 years.Postoperative complications included 1 case of wound infection and 2 cases of joint cavity effusion.The incidence of postoperative complications was 4.0%.During the follow-up period,there were no complications such as revision and prosthesis loosening.Conclusion1.The patients undergoing RA joint replacement are older,have a long course of disease,have large joint involvement and are prone to joint deformity.2.Age,course of disease and BMI may be were the risk factors for joint replacement in RA patients.3.The prognosis of RA patients undergoing joint replacement is good.