FRI0580 DISCORDANCE BETWEEN OBJECTIVE ELBOW ASSESSMENT AND PATIENTS REPORTED OUTCOMES (PROS) AFTER TOTAL ELBOW ARTHROPLASTY IN PATIENTS WITH RHEUMATOID ARTHRITIS.
Authors: R. Harada, K. Nishida, Y. Nasu, R. Nakahara
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patient-reported outcomes (PROs) have become widespread in daily clinical evaluation in patients with rheumatoid arthritis (RA). However, there are few reports for the relationship or discordance between the subjective assessment by the physician and the objective assessment by the patient with RA in surgical treatment. Objectives: We examined the relationship or discordance about the PROs in patients with RA who underwent total elbow arthroplasty (TEA). Methods: We retrospectively identified 53 elbows of 48 patients with RA who underwent TEA at Okayama University Hospital, collected from January 2012 to December 2016. We collected clinical data for the grip strength, range of motion, the Mayo Elbow Performance Scale (MEPS) as objective assessments, and the Patient-Related Elbow Evaluation (PREE), Disability of the Arm, Shoulder, and Hand (DASH) Japanese version and Hand20 as subjective assessments. For statistical analysis, we performed t-tests for pre- and post-operative physical findings and subjective evaluations, and Spearman rank correlation to examine the relationship between objective and subjective assessments. Results: The mean age of the patients at the time of arthroplasty was 63 years, the average disease duration was 23 years, and the average postoperative observation period was 32 months. The average DAS28-CRP was 3.01, and biological uses were 18 cases. The range of motion of the elbow joint and the grip strength was significantly improved postoperatively. All outcome assessments improved significantly except for HAQ (see table1). There was significantly correlated PREE with DASH, Hand20, and MEPS preoperatively. Postoperative PREE showed a significant and robust correlation in postoperative DASH, Hand20, whereas not associated with postoperative MEPS (see table2). To investigate the discordance between PREE and MEPS after TEA, we focused on changes in each item of PREE. Pain- and reach-related items improved postoperatively. But, it was difficult to improve in items affected by hand and finger functions, such as “tie shoelaces.” To explore the effects of finger and hand functions on postoperative assessments, we performed multiple regression analyses. Both preoperative grip strength (unstandardized coefficient [Β] =-0.07; 95%CI -0.148 to -0.006, t value=-2.18, P=0.03) and preoperative Hand20 (B = 0.27, 95%CI 0.029 - 0.518, t=2.25, p=0.02) were significant predictors of postoperative PREE. Conclusion: Surprisingly, the PROs of patients and the surgeon’s evaluations correlated well before surgery but resulted in discordance after TEA. We improved elbow functions by TEA, but since rheumatoid arthritis was a polyarticular disorder, improvement of a single joint function did not improve utterly subjective assessment in patients with RA. We found that the upper limb functions after TEA were significantly affected by preoperative finger and hand function. A rheumatologist should consider the dysfunctions of finger and hand when planning for elbow surgery in patients with RA. Table 1. Pre- and postoperative range of motion of elbow and forearm, grip strength, and measurement Characteristic Preoperative Postoperative P value Elbow flexion, degree 116 ± 19 134 ± 9 &lt; 0.001 - extension -34 ± 21 -25 ± 16 0.005 - total arc 82 ± 32 109 ± 19 &lt; 0.001 Grip power, mmHg 106 ± 66 130 ± 74 0.007 DASH 50.5 ± 20.5 35.8 ± 25.4 &lt; 0.001 Hand20 60.4 ± 19.1 38.9 ± 29.6 &lt; 0.001 PREE 55.6 ± 18.8 18.5 ± 17.1 &lt; 0.001 - pain 29.7 ± 11.3 6.5 ± 7.9 &lt; 0.001 - function 25.9 ± 11.5 12.0 ± 11.9 &lt; 0.001 - specific function 56.9 ± 25.5 25.4 ± 25.3 &lt; 0.001 - usual function 20.8 ± 11.3 10.5 ± 11.3 &lt; 0.001 HAQ-DI 1.06 ± 0.70 1.07 ± 0.80 0.607 MEPS 51.3 ± 16.6 97.9 ± 3.6 &lt; 0.001 Table 2. Spearman’s correlation coefficients for pre- and postoperative PREE score* Questionnaire Preoperative Correlation estimate P value Postoperative Correlation estimate P value DASH 0.56 &lt; 0.0001 0.84 &lt; 0.0001 Hand20 0.58 &lt; 0.0001 0.84 &lt; 0.0001 MEPS - 0.39 &lt; 0.01 -0.27 N.S. Disclosure of Interests: ryozo harada: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Yoshihisa Nasu: None declared, Ryuichi Nakahara: None declared