THU0094 Systemic Effect of Wrist Surgery on Quality of Life and Mental Wellness for The Patients with Rheumatoid Arthritis

BackgroundBy a remarkable advance in the medical treatment of rheumatoid arthritis (RA), uncontrollable synovitis in the past has been well comtrolled. However, some patients still have a problem in their wrist due to structural damage and smoldering synovitis. Surgical reconstruction for the wrist is required, if the conservative treatment failed. Recently, patients desired to achieve functional remission aiming at the higher level of quality of life (QOL) and the mental wellness.ObjectivesThe objective of this study was to clarify the systemic effect of wrist surgery on the disabled patients with RA using the assessment of patient-reported outcome (PRO) and disease activity.MethodsSurgical reconstruction was scheduled on 74 wrists in 74 patients (male:10, female:64) with RA between October 2012 and September 2014. The average age was 62 (19–88) years old and the average duration of the disease was 14 (1–60) years. Correction of the thumb and the finger deformities were combined in 18 wrist surgeries. The procedure included Darrach procedure (ulnar head resection) in 55 wrists, radiolunate arthrodesis in 31, Sauvé-Kapandji operation in 11, extensor tendon reconstruction in 11 etc. Steinbrocker stage I, II, III, IV was 2, 22, 29, 21 patients, and Steinbrocker class I,II, III, IV was 7, 47, 20, 0 patient(s), respectively. MTX was used in 48 patients (65%) with the average dose of 8.7mg/w, and PSL was used in 45 patients (61%) with the average dose of 4.1mg/d. Biologics was used in 12 patients (16%) including ETN:2, TCZ:3, IFX:3, ADA:3 patients. PRO was assessed by Health Assessment Questionnaire-Disability Index (HAQ-DI), EuroQol-5 Dimensions (EQ-5D), Beck Depression Inventory-II (BDI-II), and patient's general health using visual analogue scale of 100mm (Pt-GH). Upper extremity function was assessed by Disabilities of the Arm, Shoulder and Hand (DASH). Disease activity was assessed by 28-joint Disease Activity Score using C reactive protein (DAS28-CRP). They were measured just before surgery (baseline), at 6 and 12 months after surgery.ResultsAs a whole, physical function (HAQ-DI, DASH), QOL (HAQ-DI, EQ-5D, Pt-GH) and mental wellness (BDI-II, Pt-GH), disease activity (DAS28-CRP) significantly improved at 6 and 12 months after surgery compared to those at baseline (p