CLINICAL AND IMMUNOLOGICAL CORRECTION IN PATIENTS WITH RHEUMATOID ARTHRITIS UNDERGOING TOTAL KNEE ARTHROPLASTY: A CYTOKINE-GUIDED, FIRST REAL-WORLD MULTICENTER STUDY FROM UZBEKISTAN

Abstract

Background. Rheumatoid arthritis (RA) was a progressive autoimmune disease that frequently led to irreversible knee joint damage and the need for total knee arthroplasty (TKA). Persistent immune activation after surgery impaired postoperative rehabilitation, increased the risk of complications, and adversely influenced long-term prosthesis survival. Objectives. This study evaluated the effectiveness and safety of a cytokine-guided postoperative immunological strategy in patients with RA who had undergone TKA in a real-world multicenter cohort in Uzbekistan. Methods. The present prospective observational study commenced in January 2024 and was conducted for 52 weeks in three tertiary centers in Uzbekistan. The unilateral TKA was performed in 106 adults who met the ACR/EULAR 2010 criteria for RA. Serum levels of TNF-α, IL-6, and IL-1β were assessed by ELISA at baseline and at weeks 4, 13, 26, and 52 after surgery. Patients were stratified according to the dominant cytokine profile and given personalized systemic anti-rheumatic therapy. The primary outcome was DAS28, while secondary outcomes were HAQ-DI, pain intensity assessed by VAS, ESR, CRP, cytokine kinetics, and adverse events. Results. The mean age was 53.1±9.7 years, of which 73.6% were female. The mean DAS28 at baseline was 5.61±0.68 and HAQ-DI was 2.09±0.40. DAS28 decreased significantly at week 52 to 2.39±0.48 (p<0.001) and HAQ-DI to 0.88±0.30 (p<0.001). Serum cytokines decreased significantly: TNF-α (62%), IL-6 (58%), IL-1β (49%) all p<0.001. At follow-up no incidents of periprosthetic joint infection, mechanical prosthesis loosening, or cytokine-related serious adverse events were reported. Conclusions. Postoperative correction with a cytokine-guided strategy in patients with RA following TKA had an effect on disease activity, functional status, and systemic inflammation without an increase in risk for postoperative complications.