Background: Total joint replacement (TJR) surgery is an important severe long-term outcome of rheumatoid arthritis (RA), but relatively little is known about changes of its incidence in patients with RA over the past two decades.
Methods: A population-based, retrospective, incidence case review was conducted to analyze the frequency of primary TJR surgery of the knee and hip in all patients, and specifically in patients with RA in Central Finland between 1986 and 2003. Patients with TJR surgery of the knee and hip were identified in hospital databases over the 18 year period. Age-standardized incidence rate ratios for the primary TJR of the knee and hip were calculated, stratified to gender and diagnosis, with year 1986 as the reference value.
Results: The age-adjusted incidence rate ratios [with 95% confidence intervals (95%CI)] in non-RA patients for TJR of the knee increased 9.8 fold from 1986 to 2003 in females and males, and for TJR of the hip 1.8 fold in females and 2.0 fold in males. By contrast, no meaningful change was seen over this period, in age-adjusted incidence rate ratios for TJR of the knee or hip in patients with RA, ranging from 0.7 to 1.2 in 2003 compared to 1986.
Conclusion: TJR surgery prevalence has increased 2-10 fold in non-RA patients, associated with an aging population, but has not increased in patients with RA between 1986 and 2003. These data are consistent with emerging evidence that long-term outcomes of RA have improved substantially, even prior to availability of biological agents.
- joint replacement
- long-term outcomes
- rheumatoid arthritis