Purpose: To study the prevalence of orthopaedic surgery and to evaluate possible predictive factors for large joint replacements in patients with early RA.
Patients and methods: A cohort of 183 patients with early RA was monitored for 16-20 years after recruitment in 1985-89. There were 116 (63.7%) women. Mean (SD) age was 51.4 (12.4) years and mean (SD) duration of symptoms before inclusion was 12 (7) months The mean (SD) follow up duration of all patients included in this study was 16 (4) years. Occurrence of orthopaedic surgery was recorded continuously. A first prosthesis of a large joint (shoulder, elbow, wrist, hip, knee or ankle) was used as outcome variable in the predictive analyses.
Results: In total, 386 orthopaedic interventions were performed in 106/183 (58%) patients during the follow up and first large joint replacement was performed in 44/183 (24%) patients. Using Cox regression model HAQ, CRP, ESR at inclusion and radiographic changes in small joints after 1 year were found associated with increased risk of receiving prosthesis of large joints.
Conclusion: In this cohort of RA patients monitored from early disease stage, orthopaedic surgical procedures were performed in more than half of the patients. This included large joint replacements in 24% of the cases. Easily available measures were identified as predictors of such joint replacements. This study could serve as a reference for comparison with cohorts of RA patients recruited today in which new more efficacious treatment modalities are used.
- large joint replacement
- orthopaedic surgery
- radiographic changes
- rheumatoid arthritis