Background There is little information on the effect of biological treatment on the incidence and outcomes of joint replacement surgery. The results from a single centre in Brazil show a reduction in the number of total joint replacements that occurred simultaneously with induction of biologic therapies, which is in line with a Japanese report [1,2]. Another study from Sweden found that while the incidence of hip replacements decreased, the incidence of knee replacements increased .
Objectives The aim was to study if treatment with biologic drugs alters the need for primary and revision joint replacement surgery or prosthesis survival in patients with rheumatoid arthritis (RA).
Methods The study population was composed of two cohorts of patients (Register of biologic treatment in Finland (ROB-FIN) and the Central Finland RA database) from 1999-2010. Records of joint replacements performed between 1980 and 2010 were acquired from the Finnish Arthroplasty Register. Propensity score matching was used to equalize patient characteristics between biologics and DMARD users. The incidence rates of primary and revision operations were compared between the two treatment groups. Kaplan-Meier survival analysis was used to analyze prosthesis survival.
Results Of the 2,102 biologics and 2,710 DMARD users identified from the registries, 1,587 were included in both groups after matching. Median follow-up times in the matched population were 3.1 and 8.0 years, respectively. There were more primary operations per 100 patient years in the biologics (3.89, CI95% 3.41-4.41) vs. DMARD (2.63, 2.35-2.94) group but slightly fewer revisions (0.65, 0.46-0.88 vs. 0.83, 0.68-1.01). Biologics users were more likely to receive a joint replacement to small joints (p<0.001). The survival of the prostheses installed during or prior to follow-up was similar in both cohorts.
Conclusions Biologics users had more primary joint replacement operations during follow-up compared to matched DMARD users. Despite possibly lower rate of revisions among biologic users, the durability of prostheses was not improved.
Momohara S, Inoue E, Ikari K, et al. Decrease in orthopaedic operations, including total joint replacements, in patients with rheumatoid arthritis between 2001 and 2007: data from Japanese outpatients in a single institute-based large observational cohort (IORRA). Annals of the rheumatic diseases 2010;69:312–3.
De Piano LPA, Golmia RP, Scheinberg MA. Decreased need of large joint replacement in patients with rheumatoid arthritis in a specialized Brazilian center. Clinical rheumatology 2011;30:549–50.
Hekmat K, Jacobsson L, Nilsson J-Å, et al. Decrease in the incidence of total hip arthroplasties in patients with rheumatoid arthritis - results from a well defined population in south Sweden. Arthritis research & therapy 2011;13:R67.
Disclosure of Interest None Declared
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