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Rotator cuff surgery in patients with rheumatoid arthritis: clinical outcome comparable to age, sex and tear size matched non-rheumatoid patients.

Abstract Aims This study aimed to compare the clinical outcomes of rotator cuff repair in patients with rheumatoid arthritis with those of patients who have no known history of the disease. We hypothesised that the functional outcomes are comparable between patients and without rheumatoid arthritis and may be affected by the level of disease activity, as assessed from C-reactive protein (CRP) level and history of systemic steroid intake. Patients and methods We conducted a retrospective review of the institutional surgical database from May 1995 to April 2012. Twenty-nine patients with rheumatoid arthritis who had rotator cuff repair were enrolled as the study group. Age, sex, and tear size matched patients with no disease who were selected as the control group. The mean duration of follow-up was 46 months (range 24-92 months). Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) questionnaire, Constant score and visual analogue scale (VAS). All data were recorded preoperatively and at regular postoperative follow-up visits. CRP was measured preoperatively as the disease activity marker for rheumatoid arthritis. Medication history was thoroughly reviewed in the study group. Results In patients with rheumatoid arthritis, all shoulder functional scores improved after surgery (ASES 56.1-78.1, Constant 50.8-70.5 and VAS 5.2-2.5; P < 0.001). The functional outcome of surgery in patients with rheumatoid arthritis was comparable to that of the control group (difference with control: ASES 78.1 vs. 85.5, P = 0.093; Constant 70.5 vs. 75.9, P = 0.366; VAS 2.5 vs. 1.8, P = 0.108). Patients with rheumatoid arthritis who had an elevated CRP level (> 1 mg/dl) showed inferior clinical outcomes than those with normal CRP levels. Patients with a history of systemic steroid intake showed inferior functional outcomes than those who had not taken steroids. Conclusions Surgical intervention for rotator cuff tear in patients with rheumatoid arthritis improved the shoulder functional outcome comparable to that in matched patients without rheumatoid arthritis. Elevated preoperative CRP level and history of systemic steroid intake portend inferior functional outcome in patients with rheumatoid arthritis.
PMID
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Authors

Mayor MeshTerms
Keywords

C-reactive protein

CRP

Clinical outcome

Rheumatoid arthritis

Rotator cuff repair

Steroid

Journal Title annals of the royal college of surgeons of england
Publication Year Start




PMID- 28853601
OWN - NLM
STAT- MEDLINE
DA  - 20170830
DCOM- 20170913
LR  - 20170913
IS  - 1478-7083 (Electronic)
IS  - 0035-8843 (Linking)
VI  - 99
IP  - 7
DP  - 2017 Sep
TI  - Rotator cuff surgery in patients with rheumatoid arthritis: clinical outcome
      comparable to age, sex and tear size matched non-rheumatoid patients.
PG  - 579-583
LID - 10.1308/rcsann.2017.0107 [doi]
AB  - Aims This study aimed to compare the clinical outcomes of rotator cuff repair in 
      patients with rheumatoid arthritis with those of patients who have no known
      history of the disease. We hypothesised that the functional outcomes are
      comparable between patients and without rheumatoid arthritis and may be affected 
      by the level of disease activity, as assessed from C-reactive protein (CRP) level
      and history of systemic steroid intake. Patients and methods We conducted a
      retrospective review of the institutional surgical database from May 1995 to
      April 2012. Twenty-nine patients with rheumatoid arthritis who had rotator cuff
      repair were enrolled as the study group. Age, sex, and tear size matched patients
      with no disease who were selected as the control group. The mean duration of
      follow-up was 46 months (range 24-92 months). Clinical outcomes were assessed
      with the American Shoulder and Elbow Surgeons (ASES) questionnaire, Constant
      score and visual analogue scale (VAS). All data were recorded preoperatively and 
      at regular postoperative follow-up visits. CRP was measured preoperatively as the
      disease activity marker for rheumatoid arthritis. Medication history was
      thoroughly reviewed in the study group. Results In patients with rheumatoid
      arthritis, all shoulder functional scores improved after surgery (ASES 56.1-78.1,
      Constant 50.8-70.5 and VAS 5.2-2.5; P &lt; 0.001). The functional outcome of surgery
      in patients with rheumatoid arthritis was comparable to that of the control group
      (difference with control: ASES 78.1 vs. 85.5, P = 0.093; Constant 70.5 vs. 75.9, 
      P = 0.366; VAS 2.5 vs. 1.8, P = 0.108). Patients with rheumatoid arthritis who
      had an elevated CRP level (&gt; 1 mg/dl) showed inferior clinical outcomes than
      those with normal CRP levels. Patients with a history of systemic steroid intake 
      showed inferior functional outcomes than those who had not taken steroids.
      Conclusions Surgical intervention for rotator cuff tear in patients with
      rheumatoid arthritis improved the shoulder functional outcome comparable to that 
      in matched patients without rheumatoid arthritis. Elevated preoperative CRP level
      and history of systemic steroid intake portend inferior functional outcome in
      patients with rheumatoid arthritis.
FAU - Lim, S J
AU  - Lim SJ
AD  - Asan Medical Center, School of Medicine, University of Ulsan , Seoul , Korea.
FAU - Sun, J-H
AU  - Sun JH
AD  - Department of Orthopaedic Surgery, Hi Hospital , Incheon , Korea.
FAU - Kekatpure, A L
AU  - Kekatpure AL
AD  - Department of Orthopaedic Surgery, Sterling Wockhardt Hospital Vashi , Navi
      Mumbai , India.
FAU - Chun, J-M
AU  - Chun JM
AD  - Asan Medical Center, School of Medicine, University of Ulsan , Seoul , Korea.
FAU - Jeon, I-H
AU  - Jeon IH
AD  - Asan Medical Center, School of Medicine, University of Ulsan , Seoul , Korea.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Ann R Coll Surg Engl
JT  - Annals of the Royal College of Surgeons of England
JID - 7506860
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Arthritis, Rheumatoid/*complications
MH  - C-Reactive Protein
MH  - Case-Control Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Rotator Cuff Injuries/*complications/surgery
MH  - Severity of Illness Index
MH  - Sex Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - C-reactive protein
OT  - CRP
OT  - Clinical outcome
OT  - Rheumatoid arthritis
OT  - Rotator cuff repair
OT  - Steroid
EDAT- 2017/08/31 06:00
MHDA- 2017/09/14 06:00
CRDT- 2017/08/31 06:00
AID - 10.1308/rcsann.2017.0107 [doi]
PST - ppublish
SO  - Ann R Coll Surg Engl. 2017 Sep;99(7):579-583. doi: 10.1308/rcsann.2017.0107.