S40 THE PATIENT-BASED OUTCOME ASSESSMENT OF RHEUMATOID UPPER-EXTREMITY SURGERIES USING THE DASH QUESTIONNAIRE

Abstract

Objective: The objective of this study was to clarify the clinical outcome of upper-extremity surgeries for the rheumatoid patients using the Japanese version of the DASH Disabilities of the Arm, Shoulder and Hand questionnaire and to investigate whether the outcome was affected by the activity of the disease.

Materials and methods: One hundred and twenty seven surgical procedures in 103 rheumatoid patients (male: 26, female: 77) were included in this study. Surgeries were performed in 4 shoulders (HHR: 4), 35 elbows (TEA: 28, synovectomy: 6 etc.), 60 wrists (Kapandji: 6, radiolunate arthrodesis: 28, total arthrodesis: 7, extensor tendon reconstruction: 19 etc), and 28 hands (MP Swanson: 13, PIP fusion: 7, thumb IP fusion: 4 etc.). The patients’ average age at the surgery was 61 years and an average duration of the disease was 11 years. The DASH (function/symptoms) score and DAS (Disease Activity Score) 28-CRP(4) were taken just before the surgery and an average of 1 year and 3 months after the surgery. According to the EULAR’s improvement criteria, disease activity and response to the medical treatment was determined.

Results: The preoperative DASH score decreased in 96 surgical procedures (76%) postoperatively and the average score decreased from 50 to 38 (n=127, p< 0.01). Change in the score was −17 in shoulder surgeries (n=4, p=0.17), −12 in elbow surgeries (n=35, p< 0.01), −12 in wrist surgeries (n=60, p< 0.01) and −10 in hand surgeries (n=28, p< 0.05). The DASH score in the patients with preoperative HDA (high disease activity: n=16, from 70 to 57, p< 0.01) remained high compared to those with preoperative LDA (low disease activity: n=23, from 45 to 32, p< 0.01) and MDA (moderate disease activity: n=88, from 47 to 36, p< 0.01). Decrease in the score was more prominent in the patients with good response to the medical treatment (n=34, −22, p< 0.01) than those with moderate response (n=38, −11, p< 0.01) or no response (n=55, −6, p< 0.05). There was no significant decrease in the postoperative score in the patients with increased DAS28-CRP (4) (n=26, −1, p=0.822).

Conclusions: The clinical outcome of upper-extremity surgeries for the rheumatoid patients was good. Control of the disease activity by the medical treatment proved to be one of the important factors to produce a favourable outcome of surgical treatment.