Explore the vast range of titles available.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects the joints and other organs for which there is currently no effective treatment. Mesenchymal stem cells (MSCs) have therapeutic potential due to their immunomodulatory and differentiation effects. While extensive experimental studies and clinical trials have demonstrated the effects of MSCs in various diseases, MSCs have been found to cause abnormal differentiation and tumor formation. Therefore, extracellular vesicles derived from MSCs (MSC-EVs) are more effective, less toxic, and more stable than the parental cells. MSC-EVs transfer various nucleic acids, proteins, and lipids from parent cells to recipient cells, and thus participate in chronic inflammatory and immune processes. In this review, we summarize the properties and biological functions of MSCs and MSC-EVs in RA. Improvement in our understanding of the mechanisms underlying MSC and MSC-EVs in RA provides an insight into potential biomarkers and therapeutic strategies for RA.

Background Patient satisfaction has increasingly been recognized as an important measure after total knee arthroplasty (TKA). However, we do not know yet how and why the patients are satisfied or dissatisfied with TKA. Questions/purposes We asked: (1) After TKA, how satisfied are patients and which activities were they able to do? (2) Are patient-derived scores related to physician-derived scores? (3) Which factors affect patient satisfaction and function? Methods We retrospectively evaluated 375 patients who had undergone 500 TKAs between February 22, 2000 and December 1, 2009. We sent a questionnaire for The 2011 Knee Society Knee Scoring System to the patients. We determined the correlation of patient- and physician-derived scores and factors relating to the five questions relating to satisfaction and the 19 questions relating function. The minimum followup was 2 years (mean, 5 years; range, 2–11 years). Results The mean score for symptoms was 19 (74%), 23 (59%) for patient satisfaction, 10 (64%) for patient expectations, and 53 (53%) for functional activities. We found a poor correlation between the patient-derived and the physician-derived scores. Old age and varus postoperative alignment negatively correlated with the satisfaction. Varus alignment and limited range of motion (ROM) negatively correlated with the expectation. Old age, rheumatoid arthritis, and limited ROM negatively correlated with the functional activities. Conclusions Most patients did not report symptoms, but they experienced difficulty with activities of daily living after TKA. Patient satisfaction is difficult to measure, but avoiding varus alignment and achieving better ROM appear to be important for increasing satisfaction and meeting expectations. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

ObjectivesTo measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles.DesignCross-sectional study using routinely collected data.SettingNational Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care.ParticipantsStudy participants had a diagnosis of osteoarthritis or rheumatoid arthritis.InterventionsPrimary TKR, primary THR, revision TKR and revision THR.Primary outcome measuresLength of stay and hospital reimbursement.Results10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included.ConclusionsLength of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency.

Previous evidence suggest bone and cartilage damage is the main pathogenesis of rheumatoid arthritis joint destruction. However, the role of meniscus usually has not been thoroughly explored. Here, we identify CD142 + synovial fibroblasts as a subset located at sublining layer in normal and osteoarthritis synovium, which is increased and distributed at lining layer in rheumatoid arthritis synovium. Injection of CD142 + fibroblasts into DBA/1 male mice’s knee destructs meniscus but has slight effect on cartilage. ABCC4 is highly expressed in CD142 + fibroblasts, whose blockage by MK571 attenuates CD142 + fibroblasts-induced meniscus destruction through cAMP/PKA signaling. Long-term follow-up of rheumatoid arthritis cohort indicates that enriched CD142 + fibroblasts at lining layer are a risk factor for severe knee joint destruction and eventually undergo total knee arthroplasty. Our results demonstrate CD142 + fibroblasts as an indicator to assess prognosis and a therapeutic target to inhibit meniscal destruction, thereby alleviating rheumatoid arthritis knee joint damage. CD142 + synovial fibroblasts drive meniscus damage in rheumatoid arthritis via ABCC4/cAMP/PKA signaling. Here, the authors show that targeting CD142 + synovial fibroblasts might prevent knee joint destruction and reduce need for knee replacement in pre-clinical models.

Arthroplasty is indicated for patients with rheumatoid arthritis (RA) who experience significant joint damage, including bone erosions, cartilage degradation and joint deformities. However, studies on its associations with all-cause mortality, cardiovascular disease (CVD), and venous thromboembolism (VTE) among patients with RA are scarce. Our aim was to evaluate the relation of knee arthroplasty or hip arthroplasty to all-cause mortality, relative risk of CVD and incident VTE among patients with RA. We included patients with RA (ages≥20 years) from a large United Kingdom primary care database (i.e., IQVIA Medical Research Database). The primary outcome was all-cause mortality (n = 4,774 for knee arthroplasty, n = 3,362 for hip arthroplasty). The secondary outcomes included incident CVD (n = 4,350 for knee arthroplasty, n = 2,390 for hip arthroplasty) and incident VTE (n = 4,574 for knee arthroplasty, n = 3,174 for hip arthroplasty). We conducted propensity score-matched cohort studies to compare the risks of each outcome between subjects with and without knee arthroplasty (n = 2,387 each) and those with and without hip arthroplasty (n = 1,681 each), respectively. We found that subjects with knee arthroplasty had a 23% lower risk of mortality than those without knee arthroplasty (HR: 0.77, 95%CI: 0.65–0.90). Similarly, a lower, albeit non-statistically significant, risk of mortality was observed among subjects with hip arthroplasty than those without arthroplasty (HR: 0.87, 95%CI: 0.73–1.04). Compared with those without arthroplasty, subjects with knee or hip arthroplasty had a lower risk of CVD. The corresponding HRs were 0.86 (95%CI: 0.73–1.01) and 0.84 (95%CI: 0.69–1.02), respectively. Both subjects with knee or hip arthroplasty showed a higher risk of VTE than their counterparts (HR for knee arthroplasty: 1.63 [95%CI: 1.23–2.17]; HR for hip arthroplasty: 2.19 [95%CI: 1.54–3.11]). The associations of arthroplasty with the risks of mortality, CVD and VTE were generally consistent across strata of age and sex, with HR ranges from 0.71–3.75 for knee arthroplasty and 0.66–3.36 for hip arthroplasty. In this large population-based cohort of patients with RA, knee arthroplasty was associated with a lower risk of all-cause mortality, while both knee and hip arthroplasty were associated with a higher risk of VTE. No significant associations were observed with CVD. These findings highlight potential long-term benefits and risks of joint replacement in RA, but given the observational design and possibility of residual confounding, the results should be interpreted as associations rather than causal effects. Further studies are warranted to confirm these observations and to better understand the mechanisms underlying these associations.

ObjectivesTo investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients with RA treated with biological disease-modifying antirheumatic drugs (bDMARD) within 90 days preceding surgery compared with non-treated.MethodsRegister-based cohort study using the Danish National Patient Register, the DANBIO rheumatology register (RA-specific confounders and treatment episodes) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs.ResultsIn total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0.57–0.89)), but increased risk of PJI (SHR=1.46 (1.13–1.88)) and death (HR=1.25 (1.01–1.55)). In DANBIO, 345 of 1946 patients with RA with THA/TKA had received bDMARD treatment within 90 days preceding surgery. bDMARD-treated patients did not have a statistically significant increased risk of revision (SHR=1.49 (0.65–3.40)), PJI (SHR=1.61 (0.70–3.69)) nor death (HR=0.75 (0.24–2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12–7.34)) and increasing DAS28 (HR=1.49 (1.01–2.20)) were risk factors for mortality.ConclusionPatients with RA had a decreased 10-year risk of revision while the risk of death and PJI was increased compared with patients with OA following THA/TKA. bDMARD exposure was not associated with statistically significant increased risk of neither PJI nor death in this study. Glucocorticoid exposure and increased disease activity were associated with an increased risk of death.

Objectives The effect of biologics on cervical spine lesions (CSLs) and vital prognosis in patients with rheumatoid arthritis (RA) remains unclear. This study investigated the risk factors for a poor vital prognosis in patients with RA requiring primary cervical spine surgery for CSLs. Methods We retrospectively investigated 139 patients with RA who underwent primary cervical spine surgery between January 2001 and December 2020. The vital prognosis was calculated using the Kaplan–Meier method. Patient data were collected from medical records to analyse the risk factors for vital prognosis using univariate and multivariate Cox regression analyses. Results The vital prognosis was 62.7% at 10 years according to the Kaplan–Meier method. In univariate analysis, advanced age, lower serum albumin levels, high-dose prednisolone administration, non-use of methotrexate, and subaxial subluxation (SAS) comorbidity were significantly associated with a high risk of mortality. In multivariate analysis, advanced age, lower serum albumin levels, high-dose prednisolone administration, and SAS comorbidity were identified as risk factors for a poor vital prognosis. Conclusions SAS comorbidity, high-dose prednisolone administration, lower serum albumin levels, and advanced age exacerbate the vital prognosis in patients with RA requiring primary cervical spine surgery. Strict disease control aimed at preventing CSL progression to SAS by maintaining the nutritional status and without using steroids is necessary to improve the vital prognosis of patients with RA.

Objective This study aimed to investigate whether discontinuation of biological or targeted synthetic antirheumatic disease-modifying drugs (bDMARDs or tsDMARDs) influences the incidence of postoperative complications in patients with rheumatoid arthritis (RA) undergoing orthopedic surgery. Methods A retrospective multicenter cohort study including patients receiving bDMARDs or tsDMARDs who underwent orthopedic surgery was conducted. Data collected encompassed the duration of drug discontinuation and postoperative adverse events, such as delayed wound healing, surgical site infection (SSI), disease flare-ups, and mortality. The association between drug discontinuation and these outcomes was analyzed. Multivariate analyses were conducted to identify potential risk factors for these events. Results A total of 2,060 cases were initially enrolled. After applying inclusion and exclusion criteria, data from 1,953 patients were analyzed. No significant differences were observed between the groups regarding delayed wound healing, SSI, or mortality. However, the incidence of disease flare-ups was substantially higher in the drug discontinuation group and in the interleukin (IL)-6 inhibitor group. Multivariate analysis identified that tumor necrosis factor α and IL-6 inhibitor use was associated with a higher risk of delayed wound healing relative to T-cell function modifiers. Conclusion In orthopedic surgery for patients with RA, maintaining the standard or the half of administration interval of bDMARD appears safe in the preoperative period. However, the drug discontinuation may increase the risk of postoperative flare-ups, particularly with IL-6 inhibitors. In addition, T-cell function modifiers may be associated with a lower risk of delayed wound healing, suggesting their safety profile in this context.

Introduction Periprosthetic joint infection (PJI) remains the most devasting complication after total joint arthroplasty (TJA). There has been a significant focus on this topic in recently-published medical literature. However, relatively little has been published about PJI in patients with rheumatoid arthritis (RA), which are often physiologically frail and immunocompromised. A better understanding of PJI in this patient population is therefore crucial. The main aims of this paper are to (1) report complication and mortality rates in a cohort of PJI-RA patients; and (2) clinically characterize them. Methods Medical and surgical records of all RA PJI patients treated surgically from 2003 to 2020 were retrospectively reviewed. Medical history, physical examination, reactive protein (CRP) level, procalcitonin, white blood cell (WBC) count, joint aspiration results, and cultures were used to determine PJI. Results 54PJIs, 49 of them chronic, were treated in 53RA patients. Mean patient age was 65 yrs. (range = 32–88); 33females and 20 males (one bilateral hip). The overall mortality rate was 18.9%(n = 10), with five deaths directly attributed to PJI. Staphylococci accounted for 34 infections (63%), while 11(20.4%) had multiorganism infections and six culture-negative PJI. At the end of treatment 79.6%(n = 43) still had an implanted TJR, 7.4% (n = 4) had spacers, 5.6%(n = 3) had undergone resection arthroplasty, 3.7%(n = 2) arthrodesis, and one each amputation and exarticulation. Conclusions Mortality and specially complication rates were (are) high in this RA patients group presenting PJI. Delays to diagnosis and treatment may explain some of these poor outcomes. Level of evidence A cohort level III retrospective study.

Although the rate of total hip arthroplasty (THA) is declining among rheumatoid arthritis (RA) patients, the complex etiology of RA and associated immunomodulatory therapies may contribute to elevated risks of postoperative complications. This study aimed to evaluate in-hospital complications following THA in RA patients compared to osteoarthritis (OA) patients using a Japanese nationwide database. This retrospective study analyzed data from the Diagnosis Procedure Combination database, including THA patients between December 2011 and March 2023. The RA and OA groups were matched in a one-to-three ratio using propensity scores, considering factors such as age, sex, and comorbidities. Multivariate logistic regression was conducted to assess independent risk factors for complications. Among 353,465 patients, 3,977 underwent THA for RA and 298,326 for OA. After matching, 3,951 RA and 11,853 OA patients were included. RA was an independent risk factor for dislocation (OR: 2.783, 95% CI 1.641–4.720) and reoperation (OR: 2.254, 95% CI 1.687–3.013). No significant differences were observed in infection, periprosthetic fracture, venous thromboembolism, or mortality. RA patients undergoing THA are at higher risk for dislocation and reoperation. These findings emphasize the need for careful surgical planning and implementation to improve outcomes in RA patients.