LAUSR

Background Depression is the most frequently seen comorbidity in the patients with rheumatoid arthritis (RA) 1). Inflammatory mediators, including TNF-α, interleukin-1 and interleukin-6, affect serotonin transporters in the brain and promote low stress tolerance and depression 2). Objectives To investigate the effect of orthopaedic surgery on the mental condition of patients with RA by assessing the Beck depression inventory II (BDI-II) and to investigate the factors associated with changes in the BDI-II. Methods A prospective cohort study was performed in 294 sites of primary elective surgery in 276 patients with structural damage due to RA. The average (range) age was 6419–89 years old, and the average (range) disease duration was 161–60 years. The surgical site was the shoulder in 6 patients, elbow in 26, wrist in 74, hand in 63 (with wrist in 18), hip in 13, knee in 50, ankle in 12, and forefoot in 50. The BDI-II, EuroQol 5 dimensions (EQ-5D), Japanese version of the Stanford Health Assessment Questionnaire (J-HAQ), and disease activity score 28 using C-reactive protein4 (DAS28-CRP4) were assessed at the baseline and at 12 months after surgery. During the observational period, the number of patients using methotrexate (MTX), prednisolone (PSL), and biological disease-modifying anti-rheumatic drugs (bDMARDs) did not change significantly. The mean dose of MTX and PSL was reduced by 0.4 mg/w and 0.2 mg/d, respectively, at 12 months after surgery. Results In total, the mean BDI-II significantly improved from 13.0 to 11.5 at 12 months after surgery (p<0.01). The number of patients with depression (BDI-II ≥14) decreased from 42.8% to 34.8% (figure 1). A significant improvement in the BDI-II was noted in the elbow, wrist, hand, and forefoot surgeries (p<0.05). EQ-5D, J-HAQ, and DAS28-CRP4 also improved significantly (p<0.01) 3). A multiple regression analysis showed that the magnitude of decrease in the BDI-II (ΔBDI-II) was independently related to the Steinbrocker’s stage (95% confidence interval [CI]: 0.42, 2.39, p=0.005) and pain-visual analogue scale (VAS) (95% CI: 0.01, 0.10, p=0.02) at baseline and inversely related to matrix metalloprotainase-3 (MMP-3) (95% CI: −0.01,–0.001, p=0.03) at baseline. The BDI-II was correlated with the EQ-5D (γ=−0.049, p<0.01) and J-HAQ (γ=0.387, p<0.01) at 12 months after surgery.Abstract THU0156 – Figure 1 Distribution of BDI-II at baseline and a postop. 12mos. Conclusions Depression was ameliorated by surgical intervention in patients with RA. The mental condition is associated with the quality of life and physical function. References [1] Dougados M, et al. Ann Rheum Dis2014;73:62–8. [2] Mclnnes IB, Schett G. N Engl J Med2011;365:2205–19. [3] Ishikawa H. Orthop Sci. 2017;22:583–92. Disclosure of Interest None declared