Background Surgery still comprises a necessary part of treating RA patients, when medication fail to prevent joint destruction. Orthopaedic corrective procedures are considered a reliable and objective proxy for a destructed joint, and is an important outcome measure in RA.
Objectives To investigate how patient characteristics, time of diagnosis and treatment affect the need for orthopaedic surgery in patients with rheumatoid arthritis (RA).
Methods We reviewed the medical history of 1544 patients diagnosed with RA at Haukeland University Hospital in Bergen, Norway from 1972 to 2009, of which 1010 (mean age 57, 69% women) were included in the study. Relevant orthopaedic procedures were obtained from the Norwegian Arthroplasty Register and the hospital's administrative patient records. 693 procedures (joint synovectomies 22%, arthrodeses 21%, prostheses 41% and forefoot procedures 12%) were performed in 315 patients. Survival analyses were completed to evaluate the impact of age, sex, radiographic changes and year of diagnosis, on the risk of undergoing surgery.
Results Patients diagnosed in 1972–1985 and 1986–1998 had a relative risk (RR) of 2.4 and 2.2 (p<0.001) respectively, of surgery compared to patients diagnosed in 1999–2009. Radiographic changes at diagnosis and female sex were also significant risk factors. Disease activity at baseline did not affect the outcome. Anti-rheumatic medication was significantly different in the three time periods.
Conclusions Patients with early years of diagnosis had greatly increased risk of having an RA related procedure performed. This is probably due to the year of diagnosis being a proxy for the type and intensity of medical treatment.
Goodman SM. Rheumatoid Arthritis Therapy and Joint-replacement Surgery: Are We Making a Difference? J Rheumatol. 2016;43:833–5.
Disclosure of Interest None declared