Orthopaedic Surgery Rates Declining in Rheumatoid Arthritis

Martha Kerr

January 27, 2012

January 27, 2012 — Declining rates of orthopaedic surgery among patients with rheumatoid arthritis (RA) over the past 30 years suggest that advances in treatment are slowing progress of the disease, according to a study published online January 15 in The Journal of Rheumatology.

Courtney A. Shourt, MD, from the Department of Medicine at the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a retrospective medical record review of all orthopaedic surgeries in 813 cases of adult-onset RA in Olmsted County, Minnesota, between 1980 and 2007.

The investigators estimated incidence rates and time trends for primary total joint arthroplasty, joint reconstructive procedures, soft tissue procedures, and revision arthroplasty within 10 years of RA onset.

They divided the total study population into 2 cohorts: those followed from 1980 to 1994 and those followed from 1995 to 2007. Sex differences and mortality rates were also recorded with respect to surgery.

Dr. Shourt and colleagues report that 189 of 813 patients had at least 1 surgical procedure involving joints during follow-up. The cumulative incidence of joint surgery of any kind at 10 years after diagnosis was 27.3% for the earlier cohort compared with 19.5% for the later cohort (P = .08).

The greatest reduction was in soft tissue procedures 10 years after RA onset, which decreased from 12.1% in 1980–1994 to 6.0% in 1995–2007 (P = .012).

The incidence of knee surgery has been steadily increasing among patients diagnosed since the mid-1990s, while the incidence of hip surgery has not changed.

Women underwent surgery more often within 10 years of diagnosis (26.6%) than men (20.4%; P = .049). Obesity (body mass index of 30 mg/m2 or greater) was also associated with a high incidence of surgery, and it increased significantly from the earlier cohort to the next.

"[K]nee surgery accounted for virtually all the excess joint surgery among the obese patients," the authors write. "Still, the rate of knee surgeries declined in this cohort, while the rate of hip surgeries remained stable."

The mortality rate was more than doubled in patients undergoing joint reconstructive procedures (hazard ratio, 2.6; 95% CI, 1.8 - 3.9; P < .001) compared with those who did not.

"I think what we are seeing in clinical practice is reflected in this study," coauthor Eric L. Matteson, MD, MPH, from the Division of Rheumatology and the Department of Health Sciences Research at the Mayo Clinic, told Medscape Medical News.

"The control of the disease is improving, and patients are experiencing less damage than in the past. This is true also of the radiographic results. Patients with more recently diagnosed disease have less damage in relationship to the duration of their disease than in the past," he said.

"There has been a reduction in joint arthroplasty, with the notable exception of the hip," Dr. Matteson noted. "In this regard, patients with rheumatoid arthritis are becoming more like patients in the general population with respect to need for hip arthroplasty."

"I think overall the quality of life of patients with RA has improved in recent years, with patients having less systemic disease, lower rates of joint damage, and at least in my practice, patients are able to work longer and generally function better vocationally and vocationally.

"I think we will continue to see reduction in need for surgery due to RA, but the need for surgery related to obesity will continue to rise," Dr. Matteson concluded.

The authors have disclosed no relevant financial relationships.

J Rheumatol. Published online January 15, 2012. Abstract

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