RA Joint Damage

It’s official. Knee replacement surgeries are a good option for patients with rheumatoid arthritis (RA).

A new study confirms that total joint replacement of the knee can reverse damaging effects of RA, even acting as somewhat of a “time machine” for patients.

Most knee replacement studies up until this point have focused mainly on patients who have the wear-and-tear version of arthritis called osteoarthritis (OA).

Rheumatoid arthritis, the inflammatory, autoimmune form, has largely been left out of these studies — until now.

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What Did the Study Say?

The study, published in Arthritis & Rheumatology, was conducted by senior author Dr. Kaleb Michaud and his colleagues from the Division of Rheumatology at the University of Nebraska Medical Center, Omaha. 

It concluded that, for RA patients, a knee replacement surgery can return the joint to a better, healthier function. 

“The surgery acts like a time machine for these patients,” Michaud said in a statement to the press. “It's a very important treatment option and our study is really about showing how their lives improved afterward.” 

The surgery acts like a time machine for these patients. It's a very important treatment option.
Dr. Kaleb Michaud, University of Nebraska Medical Center

The researchers looked at 19,000 patients who had undergone total knee joint replacement surgeries between the years 1999 and 2012. It mainly focused on 834 patients with RA and 315 patients with OA. Most of the patients investigated during this study were in their mid-60s. 

Each of these patients rated their pain levels, functionality, and ability before and after the surgery.

It was found that just about all patients, regardless of the type of arthritis they had, reported decreased levels of pain 6 months after the surgery. The people with RA said they also had fewer tender joints than before the procedure.

Knee Replacement

The study was unique in that it focused primarily on the RA patients instead of lumping them in with OA patients, or looking at OA patients only. 

The recovery for this type of surgery varies between these two types of arthritis, as well, with post-op being far more difficult for people with RA for a variety of reasons ranging from disease flare-ups to risk of infection to having to go off certain medications for the operation.

Despite these additional challenges that make recovery less straightforward than it may be for other arthritis patients, RA patients seemed to do well. 

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What Do Patients and Professionals Say?

Noell Ullery Cason of Mishawaka, Indiana, has had rheumatoid arthritis since the age of 14. 

“I had a knee replacement in 2006 when I was 33. I was the youngest patient my doctor had done a complete replacement for,” she said.

While her age may have made her — and perhaps some doctors — nervous, she doesn’t regret the procedure one bit. 

“Having the surgery was one of the best decisions I've made,” said Cason. “It has completely eliminated pain in that knee. Recovery is a commitment because there is a lot of physical therapy but for me it was worth it.”

Having the surgery was one of the best decisions I've made. It has completely eliminated pain in that knee.
Noell Ullery Cason, rheumatoid arthritis patient

Physical therapists and rheumatologists agree that joint replacements are often a good option for those who qualify. While the surgeries are not without risks, they can be beneficial. Recovery, however, can be a lot of work, including weeks or even months of physical therapy. 

A total joint replacement isn’t always necessary for every RA patient, though. 

The most qualified applicants are RA patients who have unrelenting and destructive arthritis knee pain that isn’t otherwise responding to medical treatments. Most doctors advise that a total joint replacement be a last resort option instead of a first line of defense when it comes to managing arthritis and pain of the knee. 

And despite optimism that those with RA can have greatly improved outcomes post-surgery, the authors of the study caution that it isn’t a miracle cure.

Dr. Michaud told the press, “A new knee can give osteoarthritis patients 10 to 20 years of painless use, whereas rheumatoid arthritis continues to affect the joint soon afterward. It's an important and effective treatment, but patients with rheumatoid arthritis shouldn't expect the same, often-dramatic results experienced by their osteoarthritis counterparts.” 

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