Biologic Therapy Is Associated with Faster Bone Union After the Sauvé-Kapandji Procedure in Patients with Rheumatoid...

Area of Science:

• Orthopedics
• Rheumatology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) complicates bone healing due to chronic inflammation.
• The Sauvé-Kapandji (SK) procedure is common for distal radioulnar joint issues.
• The impact of RA medications, especially biologics, on SK bone union is unclear.

Purpose of the Study:

• To identify factors affecting bone union time after SK in RA patients.
• To investigate the specific role of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/ts DMARDs).

Main Methods:

• Retrospective analysis of RA patients undergoing SK.
• Blinded evaluation of bone union via serial radiographs by orthopedic specialists.
• Analysis of patient demographics, disease activity, medications, bone density, and biomarkers.
• Multivariate regression to identify independent predictors of union time.

Main Results:

• All patients achieved bone union.
• Biologic agents, particularly TNF inhibitors, correlated with shorter union times.
• Higher methotrexate doses and NSAID use were associated with delayed bone healing.
• Multivariate analysis confirmed MTX dose, biologic use, and NSAID use as independent predictors.

Conclusions:

• Biologic therapy is independently associated with faster bone union post-SK.
• Higher methotrexate dosage and NSAID use are linked to delayed healing.
• Findings suggest biologics may favorably impact bone union, challenging current perioperative withholding practices.