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28-03-2018 | Rheumatology | News | Article

Disease activity, CRP levels associated with postoperative flare risk in RA patients

medwireNews: Rheumatoid arthritis (RA) patients who have higher disease activity and those with elevated levels of C-reactive protein (CRP) are at increased risk for flare following surgery, researchers report.

Susan Goodman (Hospital for Special Surgery, New York, USA) and study co-authors found that flares were “frequent and severe” among 120 RA patients with a median disease duration of 14.8 years who underwent total hip (44%) or knee (56%) arthroplasty. In all, 63% of patients experienced a flare within 6 weeks of surgery, and the median severity of flares was 7 points on a 1–10 point scale.

The 75 patients who flared had a significantly higher mean Disease Activity Score at 28 joints based on erythrocyte sedimentation rate (DAS28-ESR) and median Rheumatoid Arthritis Disease Activity Index (RADAI) Joint Score at baseline than the 45 patients who did not flare, at 4.2 versus 2.9 points and 10.0 versus 5.0 points, respectively.

In a multivariable model taking factors such as disease duration and medication use into account, patients with high baseline disease activity (DAS28-ESR>5.1 points) were more than twice as likely to experience postoperative flare as those with low disease activity or in remission (DAS28-ESR≤2.6 points), with an odds ratio (OR) of 2.11.

Log-transformed RADAI score (OR=2.97) and baseline CRP levels (OR=4.24) were also significant predictors of flare risk, report the researchers in The Journal of Rheumatology.

Although a numerically higher proportion of patients who flared were taking biologics (57 vs 42%) or steroids (38 vs 24%) at baseline compared with those who did not flare, the difference did not reach statistical significance, and medication use was not significantly associated with flare risk in the multivariable analysis.

“Currently, standard perioperative care is to discontinue biologics at the time of arthroplasty to mitigate infection risk,” write Goodman and colleagues.

They add that although the study could not assess flare risk over the long term, “the evidence presented here suggests that medication management decisions are not independent risk factors for postoperative flares.”

And the team concludes that future studies should analyze the relationship between postoperative flares and long-term outcomes in patients with established RA.

By Claire Barnard

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