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Garabano G, Pesciallo CA, Rodriguez J, Perez Alamino L, Tillet F, Del Sel H, Lopreite F. Early appearance of radiolucent lines around total knee arthroplasty in rheumatoid arthritis patients. How does it impact the aseptic failure rate and functional outcomes at 13 years of follow-up? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:239-246. [PMID: 37315920 DOI: 10.1016/j.recot.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Aseptic total knee arthroplasty (TKA) failure has been associated with radiolucent lines. This study aimed to determine the impact of the early appearance of radiolucent lines (linear images of 1, 2, or >2mm at the cement-bone interface) around the TKA on prosthetic survival and functional outcomes in rheumatoid arthritis (RA) patients during a 2-20 years follow-up. METHODS We retrospectively analyzed a consecutive series of RA patients treated with TKA between 2000 and 2011. We comparatively analyzed patients with and without radiolucent lines around implants. Clinical outcomes were assessed with the knee society score (KSS) collected before surgery, at years 2, 5, and 10, and at the last postoperative follow-up. The knee society roentgenographic evaluation system was used to analyze the impact of radiolucent lines around the implants at 1, 2, 5, and more than ten years of follow-up. The reoperation and prosthetic survival rates were calculated at the end of the follow-up. RESULTS The study series included 72 TKAs with a median follow-up of 13.2 years (range: 4.0-21.0), of which 16 (22.2%) had radiolucent lines. We did not observe aseptic failure, and prosthetic survival at the end of the study was 94.4% (n=68). The KSS improved significantly (p<0.001) between preoperative values at 2, 5, and 10 years and the end of follow-up, with no differences between patients with and without radiolucent lines. CONCLUSIONS Our study demonstrates that the early appearance of radiolucent lines around a TKA in RA patients does not significantly impact prosthetic survival or long-term functional outcomes at 13 years of follow-up.
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Affiliation(s)
- G Garabano
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - C A Pesciallo
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - J Rodriguez
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - L Perez Alamino
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Tillet
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - H Del Sel
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Lopreite
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
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Garabano G, Pesciallo CA, Rodríguez J, Pérez Alamino L, Tillet F, Del Sel H, Lopreite F. Early appearance of radiolucent lines around total knee arthroplasty in rheumatoid arthritis patients. How does it impact the aseptic failure rate and functional outcomes at 13 years of follow-up? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T239-T246. [PMID: 38232933 DOI: 10.1016/j.recot.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/07/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Aseptic total knee arthroplasty (TKA) failure has been associated with radiolucent lines. This study aimed to determine the impact of the early appearance of radiolucent lines (linear images of 1, 2, or > 2mm at the cement-bone interface) around the TKA on prosthetic survival and functional outcomes in rheumatoid arthritis (RA) patients during a 2-20 years follow-up. METHODS We retrospectively analyzed a consecutive series of RA patients treated with TKA between 2000 and 2011. We comparatively analyzed patients with and without radiolucent lines around implants. Clinical outcomes were assessed with the knee society score (KSS) collected before surgery, at years 2, 5, and 10, and at the last postoperative follow-up. The knee society roentgenographic evaluation system was used to analyze the impact of radiolucent lines around the implants at 1, 2, 5, and more than ten years of follow-up. The reoperation and prosthetic survival rates were calculated at the end of the follow-up. RESULTS The study series included 72 TKAs with a median follow-up of 13.2 years (range: 4.0-21.0), of which 16 (22.2%) had radiolucent lines. We did not observe aseptic failure, and prosthetic survival at the end of the study was 94.4% (n=68). The KSS improved significantly (p<0.001) between preoperative values at 2, 5, and 10 years and the end of follow-up, with no differences between patients with and without radiolucent lines. CONCLUSIONS Our study demonstrates that the early appearance of radiolucent lines around a TKA in RA patients does not significantly impact prosthetic survival or long-term functional outcomes at 13 years of follow-up.
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Affiliation(s)
- G Garabano
- Departamento de Traumatología y Ortopedia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
| | - C A Pesciallo
- Departamento de Traumatología y Ortopedia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - J Rodríguez
- Departamento de Traumatología y Ortopedia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - L Pérez Alamino
- Departamento de Traumatología y Ortopedia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - F Tillet
- Departamento de Traumatología y Ortopedia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - H Del Sel
- Departamento de Traumatología y Ortopedia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - F Lopreite
- Departamento de Traumatología y Ortopedia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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Theander L, Jacobsson LTH, Turesson C. Osteoporosis-related fractures in men and women with established and early rheumatoid arthritis: predictors and risk compared with the general population. BMC Rheumatol 2023; 7:28. [PMID: 37684705 PMCID: PMC10486097 DOI: 10.1186/s41927-023-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES To study the risk of osteoporosis-related fractures in a community-based sample of men and women with rheumatoid arthritis (RA) overall, as well as early (< 1 year of disease duration, follow-up time maximum 10 years) and established (RA diagnosis since ≥ 5 years on July 1, 1997) RA, compared with the general population. To study potential risk factors for fractures in patients with RA from baseline questionnaire data. METHODS A community-based cohort of patients with RA (n = 1928) was studied and compared to matched general population controls. Information on osteoporosis-related fractures (hip, proximal upper arm, distal forearm and vertebral fractures) during the period July 1, 1997 to December 31, 2017 was obtained by linkage to the Swedish National Inpatient Register and the Cause of Death Register. The incidence of fractures was estimated in patients and controls. Cox regression models were used to assess the relation between RA and the risk of fractures and to assess potential predictors of fractures in RA patients. Analyses were stratified by sex, and performed in all patients with RA, and in subsets with early and established RA. RESULTS The overall incidence of osteoporosis-related fractures in the RA cohort was 10.6 per 1000 person-years (95% CI 9.31; 12.0). There was an increased risk of fractures overall in both men (hazard ratio (HR) 1.55, 95% CI 1.03; 2.34) and women (HR 1.52; 95% CI 1.27; 1.83) with RA compared to controls, with significantly increased risk also in the hip. No increased risk of osteoporosis-related fractures overall was seen in patients with early RA (HR 1.01, 95% CI 0.69; 1.49). Higher age, longer duration of RA, higher HAQ scores and higher scores in the visual analogue scale for global health were predictors of fractures. CONCLUSION Both men and women with RA were at increased risk of osteoporosis-related fractures. Patients with early RA did not have significantly increased risk during the first 10 years of disease in this study.
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Affiliation(s)
- Lisa Theander
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 1B, 205 02, Malmö, Sweden.
| | - Lennart T H Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 1B, 205 02, Malmö, Sweden
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 1B, 205 02, Malmö, Sweden
- Department of Rheumatology, Skåne University Hospital, Malmö and Lund, Malmö, Sweden
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Yoon HK, Seok SO, Oh HC, Ha JW, Park S, Park SH. Joint Replacement Surgery in Patients with Rheumatoid Arthritis in South Korea: Analysis of a Large National Database. Clin Orthop Surg 2023; 15:395-401. [PMID: 37274496 PMCID: PMC10232310 DOI: 10.4055/cios21274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND We aimed to investigate the current trend of joint replacement surgery incidence in patients with rheumatoid arthritis (RA) in South Korea and to compare the incidence of joint replacement surgery in each affected joint. METHODS We performed this big data analysis to investigate the current trend of joint replacement surgery incidence in patients with RA in South Korea and to compare the incidence of joint replacement surgery in each affected joint. This retrospective study was based on data from the Korea National Health Insurance claims database. RESULTS The prevalence of RA increased every year (0.13% in 2008, 0.25% in 2016). The number of newly diagnosed patients increased from 29,184 in 2010 to 38,347 in 2016. The incidence rate of joint replacement surgery in patients with RA increased from 0.72% in 2010 to 4.03% in 2016. The knee (68.3%) was the most commonly replaced joint. The relative risk (RR) of additional joint replacement surgery was highest for the shoulder joint (RR,1.454; 95% confidence interval, 0.763-2.771). The median time from diagnosis to surgery was the shortest in the elbow joint (379 days) and the longest in the shoulder joint (955 days). The median time for each joint was short in order of the elbows, ankles, hips, knees, and shoulders (p < 0.01). CONCLUSIONS The most frequently and initially replaced joints were different, but the prevalence and incidence of RA, as well as those of joint replacement surgery, have recently increased in South Korea. Joint replacement surgery in RA was the highest for the knee joint. The median time from diagnosis to surgery was shortest for the elbow, followed by the ankle, hip, knee, and shoulder. Regardless of whether patients are symptomatic, evaluation of large joints such as the knee, elbow, ankle, and hip should be considered from an early stage.
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Affiliation(s)
- Han-Kook Yoon
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Ok Seok
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun-Cheol Oh
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Joong-Won Ha
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sunghun Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hoon Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Fernandez-Fernandez R, Moraleda-Novo L, De Armas JN, Cruz-Pardos A. Outcome measures and survivorship following total hip arthroplasty in adolescent population. INTERNATIONAL ORTHOPAEDICS 2022; 46:2785-2791. [PMID: 35945465 DOI: 10.1007/s00264-022-05536-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The most frequent indication for total hip arthroplasty (THA) in adolescent patients has been juvenile idiopathic arthritis (JIA). However, in recent years, other causes have become more prevalent. QUESTIONS/PURPOSES (1) What is the survivorship following THA across the diagnostic spectrum in adolescent population? (2) How are quality of life results affected by systemic medical conditions? METHODS We retrospectively reviewed all consecutive THA in patients under 21 years of age, performed at our Institution between 1993 and 2018. There were 34 prostheses implanted in 26 patients with a mean age of 18.4 years (range 11 to 21). The most frequent diagnosis was JIA (14 hips), followed by avascular necrosis (10 hips). Patient reported outcomes were assessed using Harris and Oxford Hip Scores (HHS and OHS), Visual Analogue Scale (VAS) and EuroQol-5D. Survivorship for revision and aseptic loosening was determined with Kaplan Meier analysis. RESULTS At final follow-up, the overall survival rate was of 89.3% at 12-year follow-up. Three acetabular components underwent revision surgery for aseptic loosening. Clinical HHS significantly improved from 37.5 to 90.6 points (p < 0.001). Mean OHH was 37.4 points, with a final VAS of 1.64 points. Mean 5Q-5D was 0.704 with an interquartile range of 0.4 to 1.0. JIA patients displayed worse pre-operative HHS scores, and at final follow-up had worse HHS, OHS, VAS and EQ-5D scores compared to the rest of the patients. Complications included three intra-operative femoral fractures, one sciatic nerve palsy and one adductor contracture. CONCLUSION THA in adolescent patients provides improved functional outcomes with acceptable revision rates at mid-term follow-up.
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Affiliation(s)
| | | | | | - Ana Cruz-Pardos
- La Paz University Hospital, Pso. Castellana 261, 28046, Madrid, Spain
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Perry TA, Silman A, Culliford D, Gates L, Arden N, Bowen C. Trends in the Utilization of Ankle Replacements: Data From Worldwide National Joint Registries. Foot Ankle Int 2021; 42:1319-1329. [PMID: 34137278 PMCID: PMC8521348 DOI: 10.1177/10711007211012947] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Over the past decade, there has been a growth in the use of ankle replacements. Data from national joint registries have shown between-country differences in the utilization of ankle replacement. The reasons for these differences are, however, not well understood. Our aims were to describe and compare the annual incidence of primary ankle replacement between countries and, to examine potential reasons for variation over time. METHODS We used aggregate data and summary statistics on ankle replacements for the period 1993 to 2019 from national joint replacement registries in Australia, Finland, New Zealand, Norway, Sweden and the United Kingdom. From the annual recorded counts of procedures, demographic data were extracted on age, sex distribution, and indication(s) for primary ankle replacement. Registry-level summary results were also obtained on data completeness, counts of hospitals/units, and health care providers performing ankle replacements annually and data collection processes (mandatory vs voluntary). Annual ankle replacement incidence for all diagnoses and, by indication categories (osteoarthritis [OA] and rheumatoid arthritis [RA]), were calculated per 100 000 residential population aged ≥18 years. RESULTS For the period with data from all 6 countries (2010-2015), New Zealand had the largest annual incidence (mean ± SD) of 3.3 ± 0.2 ankle replacement procedures per 100 000 population whereas Finland had the lowest incidence (0.92 replacements). There were no common temporal trends in the utilization of ankle replacements. Over the years studied, OA was the predominant diagnosis in the United Kingdom, Australia, and New Zealand, whereas RA was the most common indication in Scandinavia. CONCLUSION In these 6 countries, we found marked differences in the utilization of ankle replacements. Registry-related factors including data completeness and the number of hospitals/surgeons performing ankle replacements are likely to contribute to the observed between-country differences and need to be carefully considered when interpreting comparisons for this less common site for joint replacement surgery. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Thomas A. Perry
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, United Kingdom,Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom,Thomas A. Perry, BSc, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD, United Kingdom.
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, United Kingdom
| | - David Culliford
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, United Kingdom,NIHR Applied Research Collaboration (ARC), Wessex, School of Health Sciences, University of Southampton, Southampton, United Kingdom,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Gates
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom,Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, United Kingdom
| | - Nigel Arden
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom,MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Catherine Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom,Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, United Kingdom
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Chang YS, Chen JH, Lin TM, Hsu HC, Chen WS, Lin SH, Kuo PI, Lin YC, Chang CC. Effects of biologics on reducing the risks of total knee replacement and total hip replacement in rheumatoid arthritis. Rheumatology (Oxford) 2021; 61:1849-1856. [PMID: 34534283 DOI: 10.1093/rheumatology/keab671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/23/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES RA damages the joints and increases the risks of total knee replacement (TKR) and total hip replacement (THR). However, the benefits of biologics in preventing TKR or THR remain unclear. METHODS This retrospective nationwide study used the 2000-2013 claims-based National Health Insurance dataset. Biologics are reimbursed for refractory cases. The risks of TKR and THR in the biologic cohort were compared with those of age- and sex-matched csDMARD cohort. A multivariate Cox regression model was used to investigate the benefits of bDMARDs for TKR and THR. RESULTS TKR was performed in 5979 biologic cases and 11,958 matched controls, of which 249(4.16%) and 871(7.28%) cases received TKR, respectively. THR was performed in 6245 biologic cases and 12,490 matched controls, of which 159(2.55%) and 516(4.13%) cases had THR, respectively. The biologic cohort had significantly lower incidence rates of TKR (11.73 vs. 16.33/1000 person-years, P < 0.001) and THR (7.09 vs. 9.16/1000 person-years, P < 0.001). After adjustment for confounding factors, the regular bDMARD subgroup (average dose >0.95 defined daily dose/day) had significantly lower risks of TKR (aHR: 0.55, 95% CI: 0.38-0.81) and THR (aHR: 0.63, 95% CI: 0.40-0.98). Those without methotrexate use, with steroid use, with biologic switch, and overlapping antiphospholipid syndrome had significantly higher risks of TKR and THR. CONCLUSIONS Compared with the csDMARD cohort, the risks of TKR and THR in the bDMARD cohort were the same as those in the low to moderate dose subgroups and significantly lower in those with regular bDMARD use.
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Affiliation(s)
- Yu-Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital Taipei Medical University, New Taipei City, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jin-Hua Chen
- Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Min Lin
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-Ching Hsu
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Hong Lin
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital Taipei Medical University, New Taipei City, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pei-I Kuo
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Chun Lin
- Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Chi-Ching Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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Jensen R, Christensen AF, Hartlev LB, Thomsen JS, Boel L, Laursen M, Revald PH, Varnum C, Keller KK, Hauge EM. Calcified cartilage differs in patients with end-stage primary osteoarthritis and secondary osteoarthritis due to rheumatoid arthritis of the hip joint. Scand J Rheumatol 2021; 51:441-451. [PMID: 34514946 DOI: 10.1080/03009742.2021.1952754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: Despite distinct aetiologies, the end-stages of primary osteoarthritis (OA) and secondary OA are described by common radiological features. However, the morphology of the bone-cartilage unit may differ depending on the pathogenesis. In this cross-sectional study, we aimed to investigate the histological differences in the bone-cartilage unit of the femoral head between patients with primary OA and secondary OA due to rheumatoid arthritis (RA).Method: Femoral heads were obtained from 12 patients with primary OA, six patients with secondary OA due to RA, and 12 control subjects. The femoral heads were investigated using stereological methods to ensure unbiased quantification.Results: The volume (mean difference [95% confidence interval]) (2.1 [0.5;3.8] cm3, p = 0.016) and thickness (413 [78.9;747] µm, p = 0.029) of the articular cartilage and the thickness of the calcified cartilage (56.4 [0.4;113] µm, p = 0.017) were larger in patients with primary OA than in patients with secondary OA due to RA. Femoral head volume (1.2 [-3.6;6.1] cm3, p = 0.598), bone volume fraction (-1.1 [-2.8;5.1] cm3, p = 0.553), subchondral bone thickness (-2.5 [-212;207] µm, p = 0.980), and osteophyte area (25.3 [-53.6;104] cm2, p = 0.506) did not differ between patients.Conclusion: The thicker calcified cartilage in primary OA preceding the loss of articular cartilage can be attributed to endochondral ossification. Patients with secondary OA due to RA had severely thinner calcified cartilage as the pathogenesis is driven by inflammation and is characterized by a generalized and more severe loss of articular cartilage.
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Affiliation(s)
- R Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A F Christensen
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - L B Hartlev
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Randers Regional Hospital, Randers, Denmark
| | - J S Thomsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Lwt Boel
- Institute of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | - M Laursen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - P H Revald
- Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark
| | - C Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark
| | - K K Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - E-M Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Zhou VY, Lacaille D, Lu N, Kopec J, Garbuz D, Qian Y, Aviña-Zubieta JA, Esdaile J, Xie H. Has the incidence of total joint arthroplasty in rheumatoid arthritis decreased in the era of biologics use? A population-based cohort study. Rheumatology (Oxford) 2021; 61:1819-1830. [PMID: 34373899 DOI: 10.1093/rheumatology/keab643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine whether the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) was associated with reduced incidences of total hip and knee arthroplasty (THA/TKA) among patients with rheumatoid arthritis (RA) compared with osteoarthritis (OA). METHODS Using a population-based cohort in British Columbia, Canada, RA and OA patients diagnosed between 1995-2007 were divided into semi-annual cohorts according to diagnosis date. For each cohort, we calculated 8-year incidence rates of THA and TKA. We compared levels and trends of THA/TKA incidence in RA/OA patients diagnosed during pre-bDMARDs (1995-2001) and post-bDMARDs (2003-2007) periods using interrupted time-series analysis, adjusting for baseline characteristics. Adjusted 8-year TJA incidence estimated for RA/OA cohorts diagnosed five years after bDMARDs introduction were compared with expected rates assuming no bDMARDs introduction, based on extrapolation of pre-bDMARDs trends. RESULTS We identified 60,227 RA and 288,260 OA incident cases. For cohorts diagnosed pre-bDMARDs, 8-year THA/TKA incidence rates increased over time in both RA and OA. For cohorts diagnosed post-bDMARDs, these rates decreased over time in RA but continued to increase for OA. For RA, differences between the post- and pre-bDMARDs secular trends in incidence rates were -0.49 (p = 0.002) for THA and -0.36 (p = 0.003) for TKA, compared to + 0.40 (p = 0.006) and +0.54 (p < 0.001), respectively, for OA. For RA cohorts diagnosed five years after bDMARDs introduction, 8-year incidence were 26.9% and 12.6% lower for THA and TKA, respectively, than expected rates. In contrast, corresponding rates in OA were higher by 11.7% and 16.6%, respectively. CONCLUSION Arthritis onset after bDMARDs introduction is associated with a significant reduction in THA/TKA incidence in RA, but not in OA. The reduction reflects a significant improvement in RA treatment during the biological era.
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Affiliation(s)
- Vivienne Y Zhou
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Jacek Kopec
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Epidemiology, Biostatistics and Public Health Practice, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Don Garbuz
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Yi Qian
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - John Esdaile
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
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10
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Tung KK, Lee YH, Lin CC, Lee CH, Lin MC, Wei JCC. Opposing Trends in Total Knee and Hip Arthroplasties for Patients With Rheumatoid Arthritis vs. the General Population-A 14-Year Retrospective Study in Taiwan. Front Med (Lausanne) 2021; 8:640275. [PMID: 33959623 PMCID: PMC8095393 DOI: 10.3389/fmed.2021.640275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine the trend of incidence rate of total knee arthroplasty (TKA), total hip arthroplasty (THA), and TKA or THA (major joint arthroplasty, MJA) among rheumatoid arthritis (RA) population and compared them with general population (GP) in Taiwan. Methods: Incidence rates and trends of TKA, THA, and MJA were determined over a 14-year period (2000–2013) among RA patients and compared them with GP. RA of patients was diagnosed based on the ACR 1987 criteria and extracted from GP. Subanalyses of incidences of TKA, THA, and MJA by year, 10-year age group, and gender were further conducted for demographic analysis. Patient profiles were extracted from the National Health Insurance Research Database (NHIRD) for interrupted time-series analysis and cohort studies. Results: Patients enrolled were 168,457 receiving TKA, 64,543 receiving THA, and 228,191 receiving MJA surgery. Incidences of TKA, THA, and MJA in RA patients were significantly lower by 49.0, 41.5, and 41.0% compared with concomitantly rises in GP by 131.0, 25.1, and 90.0% among the GP during the study period. The dominant age population for TKA, THA, and MJA were those aged 70–79 years in both GP and RA groups. Conclusions: We found an opposing trend in incidence of TKA, THA, and MJA between RA patients and the GP. The possible influence of pharmacological treatment is implicated for the lower incidence rates of TKA, THA, and MJA surgeries among RA patients.
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Affiliation(s)
- Kuan-Kai Tung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yung-Heng Lee
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan.,Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan.,Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Chuan-Chao Lin
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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11
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Lee YH, Ko PY, Kao SL, Lin MC, Cheng-Chung Wei J. Risk of Total Knee and Hip Arthroplasty in Patients With Rheumatoid Arthritis: A 12-Year Retrospective Cohort Study of 65,898 Patients. J Arthroplasty 2020; 35:3517-3523. [PMID: 32778419 DOI: 10.1016/j.arth.2020.06.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an inflammatory disease that causes the destruction of soft tissues and cartilage around joints. Owing to the widespread use of potent disease-modifying antirheumatic drugs, the need for total knee and hip arthroplasties (TKA and THA) has been reduced in patients with RA. However, the current association between RA and either THA or TKA has not been demonstrated in large-scale epidemiological studies. METHODS We conducted a large-scale retrospective cohort study of patients diagnosed with RA during a 12-year period (2000-2012) in Taiwan. We recruited 32,949 patients with RA and 32,949 individually propensity score-matched non-RA controls. RESULTS After adjusting for confounding factors, we found that the risk of THA or TKA was 4.02 times higher in patients with RA than in those without RA (95% confidence interval [CI], 3.77-4.52). The risk of THA or TKA was highest in patients with RA younger than 40 years (adjusted hazard ratio, 43.18; 95% CI, 16.01-116.47). Compared with non-RA patients, patients with RA were 4.82 times more likely to undergo THA (95% CI, 3.84-6.04), 3.85 times more likely to undergo TKA (95% CI, 3.48-4.25), and 19.06 times more likely to undergo both THA and TKA (95% CI, 8.90-40.80). CONCLUSION These findings document a 4.02-fold greater long-term risk of undergoing THA or TKA in RA patients relative to non-RA patients in Taiwan.
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Affiliation(s)
- Yung-Heng Lee
- Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan; Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan; Department of Center for General Education, National United University, Miaoli, Taiwan
| | - Po-Yun Ko
- Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Su-Ling Kao
- Department of Human Resource, Chia Yi Hospital, Ministry of Health and Welfare, Chia Yi, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Rheumatology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China; Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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12
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Taylor-Williams O, Nossent J, Inderjeeth CA. Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades. Rheumatol Ther 2020; 7:685-702. [PMID: 33000421 PMCID: PMC7695804 DOI: 10.1007/s40744-020-00238-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/19/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Over the past several decades, management of rheumatoid arthritis (RA) has evolved significantly, but few studies have examined the real-world impact of these changes on orthopaedic surgery in patients with RA. This systematic review assessed total hip arthroplasty (THA) incidence and postoperative complication rates across the past four decades. METHODS This is a systematic literature review sourcing data on THA in patients with RA from the electronic databases MEDLINE, EMBASE, Scopus, and Cochrane between January 1, 1980 and December 31, 2019. RESULTS The search retrieved 1715 articles of which 44 were included for quantitative synthesis. The rate for THA decreased by almost 40% from 11/1000 patient years (PY) in the 2000s to 7/1000 PY in the 2010s, while the overall complication rate decreased from 9.9% in the 1990s to 5.3% in the 2010s. Throughout the duration of the study, THA incidence and overall complication rate decreased. However, not all individual complication rates decreased. For example, revision and periprosthetic fracture decreased, infection and aseptic loosening remained constant, and dislocation increased. CONCLUSION Medical management of patients with RA has reduced the need for THA, while postoperative medical and surgical management has improved some postoperative outcomes. Nevertheless, there remains room for further improvement to postoperative outcomes through RA-specific management.
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Affiliation(s)
| | - Johannes Nossent
- School of Medicine, The University of Western Australia, Perth, Australia.
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia.
| | - Charles A Inderjeeth
- School of Medicine, The University of Western Australia, Perth, Australia.
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia.
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13
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Mei XY, Gong YJ, Safir O, Gross A, Kuzyk P. Long-term outcomes of total hip arthroplasty in patients younger than 55 years: a systematic review of the contemporary literature. Can J Surg 2020; 62:249-258. [PMID: 31348632 DOI: 10.1503/cjs.013118] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Total hip arthroplasty (THA) is increasingly performed in younger patients despite the lack of comprehensive assessment of long-term outcomes. We systematically reviewed the contemporary literature to assess the 1) indications, 2) implant selection and long-term survivorship, 3) complication and reoperation rates and 4) radiographic and functional outcomes of primary THA in patients younger than 55 years. Methods We searched the Embase and MEDLINE databases for English-language articles published between 2000 and 2018 that reported outcomes of primary THA in patients younger than 55 years with a minimum follow-up duration of 10 years. Results Thirty-two studies reporting on 3219 THA procedures performed in 2434 patients met our inclusion criteria. The most common preoperative diagnoses were avascular necrosis (1044 [32.4%]), osteoarthritis (870 [27.0%]) and developmental dysplasia of the hip (627 [19.5%]). Modular implants (3001 [93.2%]), cementless fixation (2214 [68.8%]) and metal-on-polyethylene bearings (1792 [55.7%]) were frequently used. The mean 5- and 10-year survival rates were 98.7% and 94.6%, respectively. Data on survival beyond 10 years were heterogeneous, with values of 27%–99.5% at 10–14 years, 59%–84% at 15–19 years, 70%–77% at 20–24 years and 60% at 25–30 years. Rates of dislocation, deep infection and reoperation for any reason were 2.4%, 1.2% and 16.3%, respectively. The mean Harris Hip Score improved from 43.6/100 to 91.0/100. Conclusion Total hip arthroplasty in patients younger than 55 years provides reliable outcomes at up to 10 years. Future studies should evaluate the outcomes of THA in this population at 15–20 years’ follow-up.
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Affiliation(s)
- Xin Yu Mei
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Ying Jia Gong
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Oleg Safir
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Allan Gross
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Paul Kuzyk
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
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14
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Hawley S, Edwards CJ, Arden NK, Delmestri A, Cooper C, Judge A, Prieto-Alhambra D. Descriptive epidemiology of hip and knee replacement in rheumatoid arthritis: An analysis of UK electronic medical records. Semin Arthritis Rheum 2019; 50:237-244. [PMID: 31492436 DOI: 10.1016/j.semarthrit.2019.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/08/2019] [Accepted: 08/22/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To provide descriptive data on rates of total hip replacement (THR) and total knee replacement (TKR) within a large RA cohort and describe variation in risk. METHODS Incident RA patients (1995 to 2014) were identified from the Clinical Practice Research Datalink (CPRD). First subsequent occurrence of THR and TKR were identified (analysed separately) and incidence rates calculated, stratified by sex, age, BMI, geographic region, and quintiles of the index of multiple deprivation (IMD) score. RESULTS There were 27,607 RA patients included, with a total of 1,028 THRs (mean age at surgery: 68.4 years) and 1,366 TKRs (mean age at surgery: 67.6 years), at an overall incidence rate per 1,000 person-years (PYs) [95% CI] of 6.38 [6.00-6.78] and 8.57 [8.12-9.04], respectively. TKR incidence was similar by gender but THR rates were higher in females than males. Rates of TKR but not THR rose according to BMI. An increasing trend was observed in rates of both outcomes according to age (although not ≥75) but of decreasing rates according to socio-economic deprivation. There was some evidence for regional variation in TKR. The 10-year cumulative incidence was 5.2% [4.9, 5.6] and 7.0% [6.6, 7.4] for THR and TKR, respectively. CONCLUSION We provide generalizable estimates of THR and TKR incidence in the UK RA patient population and note variation across several key variables. Increased BMI was associated with a large increase in TKR but not THR incidence. Increased deprivation was associated with a downward trend in rates of THR and TKR.
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Affiliation(s)
- Samuel Hawley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - Christopher J Edwards
- NIHR Clinical Research Facility, University Hospital Southampton, Southampton, United Kingdom
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Unviersitat Autonoma de Barcelona and Insituto de Salud Carlos III, Barcelona, Spain
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15
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Hawley S, Ali MS, Cordtz R, Dreyer L, Edwards CJ, Arden NK, Cooper C, Judge A, Hyrich K, Prieto-Alhambra D. Impact of TNF inhibitor therapy on joint replacement rates in rheumatoid arthritis: a matched cohort analysis of BSRBR-RA UK registry data. Rheumatology (Oxford) 2019; 58:1168-1175. [PMID: 30649521 PMCID: PMC6587915 DOI: 10.1093/rheumatology/key424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/03/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Previous ecological data suggest a decline in the need for joint replacements in RA patients following the introduction of TNF inhibitor (TNFi) therapy, although patient-level data are lacking. Our primary aim was to estimate the association between TNFi use and subsequent incidence of total hip replacement (THR) and total knee replacement. METHODS A propensity score matched cohort was analysed using the British Society for Rheumatology Biologics Registry (2001-2016) for RA data. Propensity score estimates were used to match TNFi users to similar conventional synthetic DMARD users (with replacement) using a 1:1 ratio. Weighted multivariable Cox regression was used to estimate the impact of TNFi on study outcomes. Effect modification by baseline age and disease severity were investigated. Joint replacement at other sites was also analysed. An instrumental variable sensitivity analysis was also performed. RESULTS The matched analysis contained a total of 19 116 patient records. Overall, there was no significant association between TNFi use vs conventional synthetic DMARD on rates of THR (hazard ratios = 0.86 [95% CI: 0.60, 1.22]) although there was significant effect modification by age (P < 0.001). TNFi was associated with a reduction in THR among those >60 years old (hazard ratio = 0.60 [CI: 0.41, 0.87]) but not in younger patients. No significant associations were found for total knee replacement or other joint replacement. CONCLUSION Overall, no association was found between the use of TNFi and subsequent incidence of joint replacement. However, TNFi was associated with a 40% relative reduction in THR rates among older patients.
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Affiliation(s)
- Samuel Hawley
- Pharmaco- and Device-Epidemiology Group, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford
| | - M Sanni Ali
- Pharmaco- and Device-Epidemiology Group, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - René Cordtz
- Centre for Rheumatology and Spine Diseases, Gentofte, Rigshospitalet
- The Parker Institute, Copenhagen University Hospital Copenhagen
| | - Lene Dreyer
- Department of Rheumatology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton
| | - Andrew Judge
- Pharmaco- and Device-Epidemiology Group, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton
- Translational Health Sciences, University of Bristol, Bristol
| | - Kimme Hyrich
- NIHR Manchester Biomedical Research Centre, NHS Foundation Trust, Manchester University, Manchester, UK
- Division of Musculoskeletal & Dermatological Sciences, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device-Epidemiology Group, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford
- GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Unviersitat Autonoma de Barcelona and Insituto de Salud Carlos III, Barcelona, Spain
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16
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Peña M, Quirós-Donate J, Pérez Fernández E, Crespí-Villarías N, Dieguez Costa E, García-Vadillo A, Espinosa M, Macía-Villa C, Morell-Hita JL, Martinez-Prada C, Villaverde V, Morado Quiroga I, Guzón-Illescas O, Barbadillo C, Fernandez Prada M, Godoy H, Herranz Varela A, Galindo Izquierdo M, Mazzucchelli R. Orthopedic Surgery in Rheumatoid Arthritis: Results from the Spanish National Registry of Hospitalized Patients over 17 Years. J Rheumatol 2019; 47:341-348. [PMID: 31203231 DOI: 10.3899/jrheum.190182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the trend of orthopedic surgery (OS) rates on patients with rheumatoid arthritis (RA). METHODS Retrospective observational study based on information provided by the Spanish National System of Hospital Data Surveillance. All hospitalizations of patients with RA for orthopedic surgery [total hip arthroplasty (THA), total knee arthroplasty (TKA), arthrodesis, and upper limb arthroplasty (ULA)] during 1999-2015 were analyzed. The age-adjusted rate was calculated. Generalized linear models were used for trend analysis. RESULTS There were 21,088 OS in patients over 20 years of age (77.9% women). OS rate adjusted by age was 754.63/100,000 RA patients/year (women 707.4, men 861.1). Neither an increasing nor a decreasing trend was noted for the total OS. However, trend and age interacted, so in the age ranges 20-40 years and 40-60 years, an annual reduction of 2.69% and 2.97%, respectively, was noted. In the age ranges over 80 years and 60-80 years, we noted an annual increase of 5.40% and 1.09%, respectively. The average age at time of OS increased 5.5 years during the period analyzed. For specific surgeries, a global annual reduction was noted in rates for arthrodesis. In THA, there was an annual reduction in patients under 80 years. In TKA and ULA, there was an annual reduction in patients under 60 years. CONCLUSION Although the overall OS rate has not changed, there is a decrease in the rate of arthrodesis at all ages, THA in patients under 80 years of age, as well as TKA and ULA in patients under 60 years of age.
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Affiliation(s)
- Marina Peña
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Javier Quirós-Donate
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Elia Pérez Fernández
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Natalia Crespí-Villarías
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Elisa Dieguez Costa
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Alberto García-Vadillo
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - María Espinosa
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Cristina Macía-Villa
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Jose Luis Morell-Hita
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Cristina Martinez-Prada
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Virginia Villaverde
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Inmaculada Morado Quiroga
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Olalla Guzón-Illescas
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Carmen Barbadillo
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Manuel Fernandez Prada
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Hilda Godoy
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Angela Herranz Varela
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - María Galindo Izquierdo
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Ramón Mazzucchelli
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain. .,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón.
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Johnson BK, Bahçe-Altuntaş A. Too Little Too Late: Effect of Poor Access to Biologics for Patients with Rheumatoid Arthritis. J Rheumatol 2019; 44:1765-1766. [PMID: 29196544 DOI: 10.3899/jrheum.171148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Beverly K Johnson
- Assistant Professor of Medicine, Albert Einstein College of Medicine, Director of Rheumatology, Jacobi Medical Center and North Central Bronx (NCB) Hospital;
| | - Asena Bahçe-Altuntaş
- Assistant Professor of Medicine, Albert Einstein College of Medicine, Director of the Joint Pain Clinic, Jacobi/NCB, New York, New York, USA
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Metcalfe D, Peterson N, Wilkinson JM, Perry DC. Temporal trends and survivorship of total hip arthroplasty in very young patients. Bone Joint J 2018; 100-B:1320-1329. [DOI: 10.1302/0301-620x.100b10.bjj-2017-1441.r2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to describe temporal trends and survivorship of total hip arthroplasty (THA) in very young patients, aged ≤ 20 years. Patients and Methods A descriptive observational study was undertaken using data from the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man between April 2003 and March 2017. All patients aged ≤ 20 years at the time of THA were included and the primary outcome was revision surgery. Descriptive statistics were used to summarize the data and Kaplan–Meier estimates calculated for the cumulative implant survival. Results A total of 769 THAs were performed in 703 patients. The median follow-up was 5.1 years (interquartile range (IQR) 2.6 to 7.8). Eight patients died and 35 THAs were revised. The use of metal-on-metal (MoM) bearings and resurfacing procedures declined after 2008. The most frequently recorded indications for revision were loosening (20%) and infection (20%), although the absolute risk of these events occurring was low (0.9%). Factors associated with lower implant survival were MoM and metal-on-polyethylene (MoP) bearings and resurfacing arthroplasty ( vs ceramic-on-polyethylene (CoP) and ceramic-on-ceramic (CoC) bearings, p = 0.002), and operations performed by surgeons who undertook few THAs in this age group as recorded in the NJR ( vs those with five or more recorded operations, p = 0.030). Kaplan–Meier estimates showed 96% (95% confidence interval (CI) 94% to 98%) survivorship of implants at five years. Conclusion Within the NJR, the overall survival for very young patients undergoing THA exceeded 96% during the first five postoperative years. In the absence of studies that can better account for differences in the characteristics of the patients, surgeons should consider the association between early revision and the type of implant, the number of THAs performed in these patients, and the bearing surface when performing THA in very young patients. Cite this article: Bone Joint J 2018;100-B:1320–9.
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Affiliation(s)
- D. Metcalfe
- Associate Professor of Orthopaedic and Trauma Surgery Oxford Trauma, NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK and Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Liverpool, UK
| | - N. Peterson
- Specialty Registrar in Trauma & Orthopaedic Surgery, Alder Hey Children’s Hospital, Liverpool, UK
| | - J. M. Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sorby Wing, Northern General Hospital, Sheffield, UK
| | - D. C. Perry
- Associate Professor of Orthopaedic and Trauma Surgery Oxford Trauma, NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK and Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Liverpool, UK
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Mazzucchelli R, Pérez Fernandez E, Crespí-Villarías N, Quirós-Donate J, García Vadillo A, Espinosa M, Peña M, Macía-Villa C, Morell-Hita JL, Martinez-Prada C, Villaverde V, Morado Quiroga I, Guzón-Illescas O, Barbadillo C, Fernández Prada M, Godoy H, Herranz Varela A, Galindo Izquierdo M, Rodriguez Caravaca G. Trends in hip fracture in patients with rheumatoid arthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999-2015). TREND-AR study. RMD Open 2018; 4:e000671. [PMID: 29955384 PMCID: PMC6018884 DOI: 10.1136/rmdopen-2018-000671] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/08/2018] [Indexed: 12/23/2022] Open
Abstract
Purpose To analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years). Methods This observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends. Results Between 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The age-adjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999–2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001). Conclusion In Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.
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Affiliation(s)
- Ramón Mazzucchelli
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Elia Pérez Fernandez
- Department of Clinical Research, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Javier Quirós-Donate
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - María Espinosa
- Department of Rheumatology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Marina Peña
- Department of Rehabilitation, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | | | | | - Virginia Villaverde
- Department of Rheumatology, Hospital Universitario de Móstoles, Madrid, Spain
| | | | - Olalla Guzón-Illescas
- Department of Rehabilitation, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Carmen Barbadillo
- Department of Rheumatology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Hilda Godoy
- Department of Rheumatology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | - Gil Rodriguez Caravaca
- Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos I, Madrid, Spain
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Hotfiel T, Carl HD, Eibenberger T, Gelse K, Weiß J, Jendrissek A, Swoboda B. Cementless femoral components in bicondylar hybrid knee arthroplasty in patients with rheumatoid arthritis: A 10-year survivorship analysis. J Orthop Surg (Hong Kong) 2018; 25:2309499017716252. [PMID: 28656874 DOI: 10.1177/2309499017716252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) has been established as a successful surgical treatment in the late stages of rheumatoid joint destruction. The purpose of this study was to review the clinical outcome and survivorship in rheumatoid arthritis (RA) patients undergoing TKA in hybrid technique with a cementless fixation of the femoral component. METHODS We analysed retrospectively 66 RA patients who underwent 72 TKAs (P.F.C. Sigma®). Mean follow-up time was 124 ± 41 months. To evaluate postoperative clinical outcome, knee injury and osteoarthritis outcome score (KOOS) and Oxford knee score (OKS) were assessed. Kaplan-Meier analysis was used to calculate survivorship. The primary outcome was revision for any reason. RESULTS Thirty-four patients (36 knees) died and two patients (2 knees) were lost to follow-up. Three patients (four knees) did not agree to participate. Twenty-seven patients (30 knees) were available for assessing clinical scores. The average scores were 85 ± 14 for KOOS and 34 ± 10 for OKS. In three patients (three knees), revision was necessary, including restricted range of motion ( n = 1), instability ( n = 1), and infection ( n = 1). There were no cases of loosening in this cohort study. The survival rates were 100% at 5 years, 97.1% at 10 years (95% CI 89.0-99.2%) and 95.6% at 15 years (95% CI 86.9-98.5%). CONCLUSIONS This study confirms that excellent clinical results and a good 10-year survivorship can be obtained with hybrid fixation technique in TKA in the unique population of RA patients.
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Affiliation(s)
- Thilo Hotfiel
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hans-Dieter Carl
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Teresa Eibenberger
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Kolja Gelse
- 2 Department of Orthopedic and Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Julian Weiß
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Jendrissek
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Bernd Swoboda
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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21
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Nystad TW, Fenstad AM, Furnes O, Fevang BT. Predictors for orthopaedic surgery in patients with rheumatoid arthritis: results from a retrospective cohort study of 1010 patients diagnosed from 1972 to 2009 and followed up until 2015. Scand J Rheumatol 2018; 47:282-290. [PMID: 29447542 DOI: 10.1080/03009742.2017.1397188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate how patient characteristics, time of diagnosis, and treatment affect the need for orthopaedic surgery in patients with rheumatoid arthritis (RA). METHOD We reviewed the medical history of 1544 patients diagnosed with RA at Haukeland University Hospital in Bergen, Norway, from 1972 to 2009, of whom 1010 (mean age 57 years, 69% women) were included in the present study. Relevant orthopaedic procedures were obtained from the Norwegian Arthoplasty Register and the hospital's administrative patient records. In total, 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 different factors such as age, gender, 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 of undergoing surgery of 2.4 and 2.2 (p < 0.001), respectively, compared to patients diagnosed in 1999-2009. Radiographic changes at diagnosis and female gender were also significant risk factors. Anti-rheumatic medication was significantly different in the three time periods. CONCLUSION Patients with a diagnosis in the early years had a greatly increased risk of having orthopaedic surgery performed. This is probably due to the year of diagnosis being a proxy for the type and intensity of medical treatment.
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Affiliation(s)
- T W Nystad
- a Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology , Haukeland University Hospital , Bergen , Norway.,b The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen , Norway
| | - A M Fenstad
- b The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen , Norway
| | - O Furnes
- b The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Medicine (K1) , University of Bergen , Bergen , Norway
| | - B T Fevang
- a Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology , Haukeland University Hospital , Bergen , Norway.,b The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen , Norway.,d Department of Clinical Sciences (K2) , University of Bergen , Bergen , Norway
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22
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Cordtz RL, Hawley S, Prieto-Alhambra D, Højgaard P, Zobbe K, Overgaard S, Odgaard A, Kristensen LE, Dreyer L. Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time-series analysis using nationwide Danish healthcare registers. Ann Rheum Dis 2017; 77:684-689. [PMID: 29247125 DOI: 10.1136/annrheumdis-2017-212424] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To study the impact of the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and associated rheumatoid arthritis (RA) management guidelines on the incidence of total hip (THR) and knee replacements (TKR) in Denmark. METHODS Nationwide register-based cohort and interrupted time-series analysis. Patients with incident RA between 1996 and 2011 were identified in the Danish National Patient Register. Patients with RA were matched on age, sex and municipality with up to 10 general population comparators (GPCs). Standardised 5-year incidence rates of THR and TKR per 1000 person-years were calculated for patients with RA and GPCs in 6-month periods. Levels and trends in the pre-bDMARD (1996-2001) were compared with the bDMARD era (2003-2016) using segmented linear regression interrupted by a 1-year lag period (2002). RESULTS We identified 30 404 patients with incident RA and 297 916 GPCs. In 1996, the incidence rate of THR and TKR was 8.72 and 5.87, respectively, among patients with RA, and 2.89 and 0.42 in GPCs. From 1996 to 2016, the incidence rate of THR decreased among patients with RA, but increased among GPCs. Among patients with RA, the incidence rate of TKR increased from 1996 to 2001, but started to decrease from 2003 and throughout the bDMARD era. The incidence of TKR increased among GPCs from 1996 to 2016. CONCLUSION We report that the incidence rate of THR and TKR was 3-fold and 14-fold higher, respectively among patients with RA compared with GPCs in 1996. In patients with RA, introduction of bDMARDs was associated with a decreasing incidence rate of TKR, whereas the incidence of THR had started to decrease before bDMARD introduction.
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Affiliation(s)
- René Lindholm Cordtz
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Gentofte, Copenhagen, Denmark.,The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Samuel Hawley
- Musculoeskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- Musculoeskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - Pil Højgaard
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Gentofte, Copenhagen, Denmark.,The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Kristian Zobbe
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Gentofte, Copenhagen, Denmark.,The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Lene Dreyer
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Gentofte, Copenhagen, Denmark.,The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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23
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Onuoha KO, Solow M, Newman JM, Sodhi N, Pivec R, Khlopas A, Sultan AA, Chughtai M, Shah NV, George J, Mont MA. Have the annual trends of total hip arthroplasty in rheumatoid arthritis patients decreased? ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:S35. [PMID: 29299482 DOI: 10.21037/atm.2017.11.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Rheumatoid arthritis (RA) is characterized by chronic systemic and synovial inflammation, resulting in damage to both cartilage and bone. Medical treatment, which has increasingly relied upon disease modifying anti-rheumatic drugs (DMARDs), may fail to slow disease progression and limit joint damage, ultimately warranting surgical intervention. Up to 25% of RA patients will require lower extremity total joint arthroplasty. Though total hip arthroplasty (THA) is known to improve quality of life and functional measures, clarification is still required with respect to the impact of increased DMARD use on annual rates of THA. Thus, the purpose of this study was to evaluate: (I) the annual trends of THAs due to RA in the United States population; (II) the annual trends in the proportion of THAs due to RA in the United States. Methods This study utilized the Nationwide Inpatient Sample (NIS) to identify all patients who underwent THA between 2002 and 2013 (n=3,135,904). Then, THA patients who had a diagnosis of RA, which was defined by the International Classification of Disease 9th revision diagnosis code 714.0, were identified. The incidence of THAs with a diagnosis of RA in the United States was calculated using the United States population as the denominator. Regression models were used to analyze the annual trends of RA in patients who underwent THA. Results Review of the database identified 90,487 patients who had a diagnosis of RA and underwent THA from 2002 to 2013. The annual prevalence of RA in those who underwent THA slightly decreased over the specified time period, with 28.7 per 1,000 THAs in 2002 and 28.6 per 1,000 THAs in 2013; however, this change was not statistically significant (R2=0.158, P=0.200). Conclusions The annual rates of THA among RA patients did not show any significant change between 2002 and 2013. DMARD use has decreased both disease progression and joint destruction, and DMARDs are now often utilized as primary treatment. The increase in population of the country during the study period may have overestimated THA trends. Moreover, patients may be more likely to opt for surgical management, given the advances in operative techniques as well as peri- and post-operative course.
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Affiliation(s)
- Kemjika O Onuoha
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center Brooklyn, New York, USA
| | - Max Solow
- St. Georges University School of Medicine, St. George's, West Indies, Grenada
| | - Jared M Newman
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center Brooklyn, New York, USA
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Pivec
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center Brooklyn, New York, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center Brooklyn, New York, USA
| | - Jaiben George
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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24
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Stamp LK, Haslett J, Chapman P, O'Donnell J, Raja R, Rothwell A, Frampton C, Hooper G. Rates of Joint Replacement Surgery in New Zealand, 1999-2015: A Comparison of Rheumatoid Arthritis and Osteoarthritis. J Rheumatol 2017; 44:1823-1827. [PMID: 29032353 DOI: 10.3899/jrheum.170551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine rates of joint replacement for people with rheumatoid arthritis (RA) and osteoarthritis (OA) and to examine the characteristics of those receiving elbow replacements. METHODS Data were extracted from the New Zealand Joint Registry from 1999 to 2015 and annual rates calculated. RESULTS Rates of joint replacement increased over time for OA but not RA. Elbow replacement was the only procedure performed more commonly in RA. CONCLUSION There has been a substantial increase in joint replacement for OA in New Zealand. For RA, where access to biologics has been limited to those with erosions, joint replacement rates have not declined, with the exception of elbow replacements.
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Affiliation(s)
- Lisa K Stamp
- From the Department of Medicine and Department of Orthopaedics, University of Otago; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand. .,L.K. Stamp, FRACP, PhD, Department of Medicine, University of Otago, and Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. Haslett, Research Coordinator, Department of Medicine, University of Otago; P. Chapman, FRACP, MD, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. O'Donnell, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; A. Rothwell, Orthopedic Surgeon, FRACS FNZOA; C. Frampton, Biostatistician, PhD, Department of Medicine, University of Otago; G. Hooper, Orthopedic Surgeon, FRACS FRNZOA, Department of Orthopaedics, University of Otago.
| | - Janine Haslett
- From the Department of Medicine and Department of Orthopaedics, University of Otago; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand.,L.K. Stamp, FRACP, PhD, Department of Medicine, University of Otago, and Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. Haslett, Research Coordinator, Department of Medicine, University of Otago; P. Chapman, FRACP, MD, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. O'Donnell, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; A. Rothwell, Orthopedic Surgeon, FRACS FNZOA; C. Frampton, Biostatistician, PhD, Department of Medicine, University of Otago; G. Hooper, Orthopedic Surgeon, FRACS FRNZOA, Department of Orthopaedics, University of Otago
| | - Peter Chapman
- From the Department of Medicine and Department of Orthopaedics, University of Otago; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand.,L.K. Stamp, FRACP, PhD, Department of Medicine, University of Otago, and Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. Haslett, Research Coordinator, Department of Medicine, University of Otago; P. Chapman, FRACP, MD, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. O'Donnell, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; A. Rothwell, Orthopedic Surgeon, FRACS FNZOA; C. Frampton, Biostatistician, PhD, Department of Medicine, University of Otago; G. Hooper, Orthopedic Surgeon, FRACS FRNZOA, Department of Orthopaedics, University of Otago
| | - John O'Donnell
- From the Department of Medicine and Department of Orthopaedics, University of Otago; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand.,L.K. Stamp, FRACP, PhD, Department of Medicine, University of Otago, and Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. Haslett, Research Coordinator, Department of Medicine, University of Otago; P. Chapman, FRACP, MD, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. O'Donnell, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; A. Rothwell, Orthopedic Surgeon, FRACS FNZOA; C. Frampton, Biostatistician, PhD, Department of Medicine, University of Otago; G. Hooper, Orthopedic Surgeon, FRACS FRNZOA, Department of Orthopaedics, University of Otago
| | - Rafi Raja
- From the Department of Medicine and Department of Orthopaedics, University of Otago; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand.,L.K. Stamp, FRACP, PhD, Department of Medicine, University of Otago, and Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. Haslett, Research Coordinator, Department of Medicine, University of Otago; P. Chapman, FRACP, MD, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. O'Donnell, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; A. Rothwell, Orthopedic Surgeon, FRACS FNZOA; C. Frampton, Biostatistician, PhD, Department of Medicine, University of Otago; G. Hooper, Orthopedic Surgeon, FRACS FRNZOA, Department of Orthopaedics, University of Otago
| | - Alastair Rothwell
- From the Department of Medicine and Department of Orthopaedics, University of Otago; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand.,L.K. Stamp, FRACP, PhD, Department of Medicine, University of Otago, and Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. Haslett, Research Coordinator, Department of Medicine, University of Otago; P. Chapman, FRACP, MD, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. O'Donnell, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; A. Rothwell, Orthopedic Surgeon, FRACS FNZOA; C. Frampton, Biostatistician, PhD, Department of Medicine, University of Otago; G. Hooper, Orthopedic Surgeon, FRACS FRNZOA, Department of Orthopaedics, University of Otago
| | - Christopher Frampton
- From the Department of Medicine and Department of Orthopaedics, University of Otago; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand.,L.K. Stamp, FRACP, PhD, Department of Medicine, University of Otago, and Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. Haslett, Research Coordinator, Department of Medicine, University of Otago; P. Chapman, FRACP, MD, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. O'Donnell, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; A. Rothwell, Orthopedic Surgeon, FRACS FNZOA; C. Frampton, Biostatistician, PhD, Department of Medicine, University of Otago; G. Hooper, Orthopedic Surgeon, FRACS FRNZOA, Department of Orthopaedics, University of Otago
| | - Gary Hooper
- From the Department of Medicine and Department of Orthopaedics, University of Otago; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand.,L.K. Stamp, FRACP, PhD, Department of Medicine, University of Otago, and Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. Haslett, Research Coordinator, Department of Medicine, University of Otago; P. Chapman, FRACP, MD, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; J. O'Donnell, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; A. Rothwell, Orthopedic Surgeon, FRACS FNZOA; C. Frampton, Biostatistician, PhD, Department of Medicine, University of Otago; G. Hooper, Orthopedic Surgeon, FRACS FRNZOA, Department of Orthopaedics, University of Otago
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25
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Hawley S, Cordtz R, Dreyer L, Edwards CJ, Arden NK, Delmestri A, Silman A, Cooper C, Judge A, Prieto-Alhambra D. Association between NICE guidance on biologic therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales: An interrupted time-series analysis. Semin Arthritis Rheum 2017; 47:605-610. [PMID: 29055489 DOI: 10.1016/j.semarthrit.2017.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/18/2017] [Accepted: 09/20/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the impact of NICE approval of tumor necrosis factor inhibitor (TNFi) therapies on the incidence of total hip replacement (THR) and total knee replacement (TKR) among rheumatoid arthritis (RA) patients in England and Wales. METHODS Primary care data [Clinical Practice Research Datalink (CPRD)] for the study period (1995-2014) were used to identify incident adult RA patients. The age and sex-standardised 5-year incidence of THR and TKR was calculated separately for RA patients diagnosed in each six-months between 1995-2009. We took a natural experimental approach, using segmented linear regression to estimate changes in level and trend following the publication of NICE TA 36 in March 2002, incorporating a 1-year lag. Regression coefficients were used to calculate average change in rates, adjusted for prior level and trend. RESULTS We identified 17,505 incident RA patients of whom 465 and 650 underwent THR and TKR surgery, respectively. The modeled average incidence of THR and TKR over the biologic-era was 6.57/1000 person years (PYs) and 8.51/1000 PYs, respectively, with projected (had pre-NICE TA 36 level and trend continued uninterrupted) figures of 5.63/1000 PYs and 12.92 PYs, respectively. NICE guidance was associated with a significant average decrease in TKR incidence of -4.41/1000 PYs (95% C.I. -6.88 to -1.94), equating to a relative 34% reduction. Overall, no effect was seen on THR rates. CONCLUSIONS Among incident RA patients in England and Wales, NICE guidance on TNFi therapies for RA management was temporally associated with reduced rates of TKR but not THR.
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Affiliation(s)
- Samuel Hawley
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD
| | - René Cordtz
- Centre for Rheumatology and Spine Diseases, Gentofte University Hospital, Rigshospitalet, Copenhagen, Denmark; The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lene Dreyer
- Centre for Rheumatology and Spine Diseases, Gentofte University Hospital, Rigshospitalet, Copenhagen, Denmark; The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christopher J Edwards
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK; Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK; Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD; GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
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26
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Bansback N, Fu E, Sun H, Guh D, Zhang W, Lacaille D, Milbers K, Anis AH. Do Biologic Therapies for Rheumatoid Arthritis Offset Treatment-Related Resource Utilization and Cost? A Review of the Literature and an Instrumental Variable Analysis. Curr Rheumatol Rep 2017; 19:54. [DOI: 10.1007/s11926-017-0680-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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27
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Modifiable risk factors and preoperative optimization of the primary total arthroplasty patient. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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28
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Hallert E, Husberg M, Kalkan A, Bernfort L. Rheumatoid arthritis is still expensive in the new decade: a comparison between two early RA cohorts, diagnosed 1996–98 and 2006–09. Scand J Rheumatol 2016; 45:371-8. [DOI: 10.3109/03009742.2015.1126344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- E Hallert
- Centre for Medical Technology Assessment, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - M Husberg
- Centre for Medical Technology Assessment, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - A Kalkan
- Centre for Medical Technology Assessment, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - L Bernfort
- Centre for Medical Technology Assessment, Division of Health Care Analysis, Linköping University, Linköping, Sweden
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29
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Goodman SM, Johnson B, Zhang M, Huang WT, Zhu R, Figgie M, Alexiades M, Mandl LA. Patients with Rheumatoid Arthritis have Similar Excellent Outcomes after Total Knee Replacement Compared with Patients with Osteoarthritis. J Rheumatol 2015; 43:46-53. [PMID: 26628605 DOI: 10.3899/jrheum.150525] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although new treatments for rheumatoid arthritis (RA) are extremely effective in preventing disease progression, rates of total knee replacement (TKR) continue to rise. The ongoing need for TKR is problematic, especially as functional outcomes in patients with RA have been reported to be worse than in patients with osteoarthritis (OA). The purpose of this study is to assess pain, function, and quality of life 2 years after TKR in contemporary patients with RA compared with patients with OA. METHODS Primary TKR cases enrolled between May 1, 2007 and July 1, 2010 in a single institution TKR registry were eligible for this study. Validated RA cases were compared with OA at baseline and at 2 years. RESULTS We identified 4456 eligible TKR, including 136 RA. Compared with OA, RA TKR had significantly worse preoperative Western Ontario and McMaster Universities Osteoarthritis Index pain (55.9 vs 46.6, p < 0.0001) and function (58.7 vs 47.3, p < 0.0001); however, there were no differences at 2 years. Within RA, there was no difference for patients who were treated with biologic disease-modifying antirheumatic drugs versus those who did not in pain (p = 0.41) or function (p = 0.39) at 2 years. In a multivariate regression, controlling for multiple potential confounders, there was no independent association of RA with 2-year pain (p = 0.18) or function (p = 0.71). Satisfaction was high for both RA and OA. CONCLUSION Patients with RA undergoing primary TKR have excellent 2-year outcomes, comparable with OA, in spite of worse preoperative pain and function. In this contemporary cohort, RA is not an independent risk factor for poor outcomes.
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Affiliation(s)
- Susan M Goodman
- From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center, and North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery.
| | - Beverly Johnson
- From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center, and North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery
| | - Meng Zhang
- From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center, and North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery
| | - Wei-Ti Huang
- From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center, and North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery
| | - Rebecca Zhu
- From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center, and North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery
| | - Mark Figgie
- From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center, and North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery
| | - Michael Alexiades
- From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center, and North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery
| | - Lisa A Mandl
- From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center, and North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery
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Pedersen AB, Mor A, Mehnert F, Thomsen RW, Johnsen SP, Nørgaard M. Rheumatoid Arthritis: Trends in Antirheumatic Drug Use, C-reactive Protein Levels, and Surgical Burden. J Rheumatol 2015; 42:2247-54. [DOI: 10.3899/jrheum.141297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 11/22/2022]
Abstract
Objective.Over the past decade, the therapeutic approach used to treat patients with rheumatoid arthritis (RA) has considerably changed. It remains unclear whether these changes have been accompanied by decreased disease severity and surgical treatment burden at the population level. Therefore, we investigated time trends in antirheumatic drug consumption, C-reactive protein (CRP) levels, and use of orthopedic surgery among Danish patients with RA.Methods.Using medical databases, we identified all patients with RA living in Northern Denmark during 1996–2012. For each calendar year, we computed the annual rate of antirheumatic drug use (1996–2010), the median CRP value in mg/l (1996–2011), and the proportions of patients who underwent hip replacement and other orthopedic procedures (1996–2012).Results.Antirheumatic drug consumption per patient increased 5-fold, from 145.0 defined daily doses (DDD) in 1996 to 695.4 DDD in 2010. Median CRP declined from 20.5 mg/l [interquartile range (IQR), 10.0 to 43.5 mg/l] in 1996 to 10.0 mg/l (IQR, 4.2–17.8 mg/l) in 2011. From 1996 to 2012, declining proportions of patients with RA underwent hip replacement (14.9% to 10.1%) and other joint operations (29.1% to 23.4%), while the annual proportion of patients who underwent soft tissue procedures increased from 20.7% to 23.4%.Conclusion.Antirheumatic drug consumption has substantially increased among patients with RA since 1996, in association with reduced disease activity (i.e., lower CRP levels), fewer joint procedures (including hip replacements), and more soft tissue procedures.
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Turesson C, Bergström U, Pikwer M, Nilsson JÅ, Jacobsson LT. High serum cholesterol predicts rheumatoid arthritis in women, but not in men: a prospective study. Arthritis Res Ther 2015; 17:284. [PMID: 26458977 PMCID: PMC4603637 DOI: 10.1186/s13075-015-0804-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Environmental exposures, including smoking, hormone-related factors, and metabolic factors, have been implicated in the etiology of rheumatoid arthritis (RA). A previous study has indicated that blood lipid levels may influence the development of RA. The objective of this study was to investigate the impact of serum total cholesterol and triglycerides on the risk of RA in a prospective study. METHODS Among participants in a large population-based health survey (n = 33,346), individuals who subsequently developed RA were identified by linkage to four different registers and a structured review of the medical records. In a nested case-control study, with controls, matched for age, sex, and year of inclusion, from the health survey database, the relation between serum lipids (levels of total cholesterol and triglycerides) and future RA development was examined. RESULTS In total, 290 individuals (151 men and 139 women) whose RA was diagnosed a median of 12 years (range of 1-28) after inclusion in the health survey were compared with 1160 controls. Women with a diagnosis of RA during the follow-up had higher total cholesterol levels at baseline compared with controls: odds ratio (OR) 1.54 per standard deviation; 95 % confidence interval (CI) 1.22-1.94. This association remained statistically significant in multivariate models adjusted for smoking and a history of early menopause and in analyses stratified by rheumatoid factor status and time to RA diagnosis. Total cholesterol had no significant impact on the risk of RA in men (OR 1.03; 95 % CI 0.83-1.26). Triglycerides did not predict RA in men or women. CONCLUSIONS A high total cholesterol was a risk factor for RA in women but not in men. This suggests that sex-specific exposures modify the impact of lipids on the risk of RA. Hormone-related metabolic pathways may contribute to RA development.
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Affiliation(s)
- Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga-Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Ulf Bergström
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga-Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Mitra Pikwer
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Eskilstuna Hospital, Kungsvägen 34, Eskilstuna, 631 88, Sweden.
| | - Jan-Åke Nilsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga-Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Lennart Th Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, Gothenburg, 413 46, Sweden.
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Ibrahim MS, Jordan RW, Kallala R, Koris J, Chakrabarti I. Total proximal interphalangeal joint arthroplasty for osteoarthritis versus rheumatoid arthritis--a systematic review. ACTA ACUST UNITED AC 2015; 20:181-90. [PMID: 25609297 DOI: 10.1142/s0218810415300016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Osteoarthritis (OA) and rheumatoid arthritis (RA) of the proximal interphalangeal joints (PIPJ) can be treated with arthroplasty, although the complicated anatomy of the joint makes surgery challenging. Controversy exists regarding outcomes in relation to disease aetiology. This study aims to compare functional outcomes and re-operation rates in these two conditions. The electronic databases MEDLINE, EMBASE, Cochrane database and Google scholar were searched in accordance with PRISMA. The study quality was assessed using the Methodological Index for Non-Randomised Studies (MINOR). A total of 16 studies were reviewed including 506 cases in the OA and 542 in the RA group. Five studies assessed function and patient satisfaction, demonstrating a non-significant improvement in the OA group. Five studies reported re-operation rate; three showing it to be lower in the OA group and two reporting similar rates. This review suggests that those undergoing PIPJ arthroplasty for OA may have a better functional outcome and lower re-operation rate.
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Affiliation(s)
- Mazin Saad Ibrahim
- University College Hospital London, 235 Euston Rd, Fitzrovia, London NW1 2BU, UK
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Dusad A, Pedro S, Mikuls TR, Hartman CW, Garvin KL, O'Dell JR, Michaud K. Impact of Total Knee Arthroplasty as Assessed Using Patient-Reported Pain and Health-Related Quality of Life Indices: Rheumatoid Arthritis Versus Osteoarthritis. Arthritis Rheumatol 2015. [DOI: 10.1002/art.39221] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Anand Dusad
- Veterans Affairs Nebraska−Western Iowa Health Care System and University of Nebraska Medical Center; Omaha
| | - Sofia Pedro
- National Data Bank for Rheumatic Diseases; Wichita Kansas
| | - Ted R. Mikuls
- Veterans Affairs Nebraska−Western Iowa Health Care System and University of Nebraska Medical Center; Omaha
| | | | | | - James R. O'Dell
- Veterans Affairs Nebraska−Western Iowa Health Care System and University of Nebraska Medical Center; Omaha
| | - Kaleb Michaud
- National Data Bank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center; Omaha
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Nystad TW, Fenstad AM, Furnes O, Havelin LI, Skredderstuen AK, Fevang BTS. Reduction in orthopaedic surgery in patients with rheumatoid arthritis: a Norwegian register-based study. Scand J Rheumatol 2015; 45:1-7. [DOI: 10.3109/03009742.2015.1050451] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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LoVerde ZJ, Mandl LA, Johnson BK, Figgie MP, Boettner F, Lee YY, Goodman SM. Rheumatoid Arthritis Does Not Increase Risk of Short-term Adverse Events after Total Knee Arthroplasty: A Retrospective Case-control Study. J Rheumatol 2015; 42:1123-30. [PMID: 25934825 DOI: 10.3899/jrheum.141251] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE More adverse events (AE) are reported after total knee arthroplasty (TKA) for patients with rheumatoid arthritis (RA) than for patients with osteoarthritis (OA). This study evaluates 6-month postoperative AE in a high-volume center in a contemporary RA cohort. METHODS Patients with RA in an institutional registry (2007-2010) were studied. AE were identified by self-report and review of office and hospital charts. Subjects with RA were matched to 2 with OA by age, sex, and procedure. RA-specific surgical volume was determined. Baseline characteristics and AE were compared and analyzed. RESULTS There were 159 RA TKA and 318 OA. Of the patients with RA, 88.0% were women, 24.5% received corticosteroids, 41.5% received biologics, and 67% received nonbiologic disease-modifying antirheumatic drugs (DMARD). There was no difference in comorbidities. RA-specific surgical volume was high; 64% of cases were performed by surgeons with ≥ 20 RA cases during the study period. Patients with RA had worse baseline pain and function and lower perceived health status (EQ-5D 0.59 vs 0.65, p < 0.01). There were no deep infections in either group and no difference in superficial infection (9.4% RA vs 10.1% OA, p = 0.82), myocardial infarction (0.7% RA vs 0% OA, p = 0.33), or thromboembolism (1.3% RA vs 0.6% OA, p = 0.60). CONCLUSION In a high-volume center, with high RA-specific experience, RA does not increase postoperative AE. Despite worse preoperative function and high steroid and DMARD use, complications were not increased. However, further study to determine generalizability is needed.
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Affiliation(s)
- Zachary J LoVerde
- From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery
| | - Lisa A Mandl
- From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery
| | - Beverly K Johnson
- From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery
| | - Mark P Figgie
- From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery
| | - Friedrich Boettner
- From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery
| | - Yuo-Yu Lee
- From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery
| | - Susan M Goodman
- From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery.
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Singh JA, Lewallen DG. Increasing obesity and comorbidity in patients undergoing primary total hip arthroplasty in the U.S.: a 13-year study of time trends. BMC Musculoskelet Disord 2014; 15:441. [PMID: 25519434 PMCID: PMC4302153 DOI: 10.1186/1471-2474-15-441] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 12/10/2014] [Indexed: 12/21/2022] Open
Abstract
Background Few, if any data are available are available regarding the time-trends in characteristics of patients who have undergone primary THA. Our objective was to examine the time-trends in key demographic and clinical characteristics of patients undergoing primary total hip arthroplasty (THA). Methods We used the data from the Mayo Clinic Total Joint Registry from 1993–2005 to examine the time-trends in demographics (age, body mass index (BMI)), medical (Deyo-Charlson index) and psychological comorbidity (anxiety, depression) and underlying diagnosis of patients undergoing primary THA. Chi-square test and analysis for variance were used. Multivariable-adjusted logistic regression (age, sex, comorbidity-adjusted) compared 1993–95 to other study periods. Odds ratio (OR) and 95% confidence interval (CI) are presented. Results The primary THA cohort consisted of 6,168 patients with 52% women. In unadjusted analyses, compared to 1993–95, significantly more patients (by >2-times for most) in 2002–05 had: BMI ≥ 40, 2.3% vs. 6.3%; depression, 4.1% vs. 9.8%; and anxiety, 3.4% vs. 5.7%; and significantly fewer had an underlying diagnosis of rheumatoid/inflammatory arthritis, 3.7% vs. 1.5% (p ≤ 0.01 for all). In multivariable-adjusted models, compared to 1993–95, significantly more patients in 2003–05 had (all p-values ≤ 0.01): BMI ≥ 40, OR, 2.79 (95% CI: 1.85, 4.22); Deyo-Charlson Index ≥ 3, 1.32 (1.07, 1.63); depression, 2.25 (1.66, 3.05); and anxiety, 1.71 (1.19, 2.15). Respectively, fewer patients had a diagnosis of RA/inflammatory arthritis: 0.28 (0.17, 0.46; p < 0.01). Over the 13-year study period, Deyo-Charlson index increased by 22% (0.9 to 1.1) and the mean age decreased by 0.7 years (65.0 to 64.3) (p < 0.01 for both). Conclusions Obesity, medical and psychological comorbidity increased and the underlying diagnosis of RA/inflammatory arthritis decreased rapidly in primary THA patients over 13-years. Our cohort characteristics are similar to previously described characteristics of national U.S. cohort, suggesting that these trends may be national rather than local trends. This is important information for policy makers to take into account for resource allocation. Studies of THA outcomes and utilization should take these rapidly changing patient characteristics into account.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA.
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Goodman SM, Ravi B, Hawker G. Outcomes in rheumatoid arthritis patients undergoing total joint arthroplasty. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/ijr.14.47] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- C Fontaine
- Service de chirurgie de la main et du membre supérieur, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU, rue du Pr-Émile-Laine, 59037 Lille cedex, France.
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Pakos EE, Paschos NK, Xenakis TA. Long Term Outcomes of Total Hip Arthroplasty in Young Patients under 30. THE ARCHIVES OF BONE AND JOINT SURGERY 2014; 2:157-162. [PMID: 25386575 PMCID: PMC4225019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND We aimed to report outcomes of total hip arthroplasty (THA) in very young patients under the year of 30. METHODS Thirty patients (45 hips) with various indications for THA were retrospectively reviewed radiologically and clinically and analyzed regarding survival, reasons of failure, factors associated with outcomes and postoperative complications. RESULTS Within a mean follow-up time of 116 months the 10-year survival rate was 90.3%. All hips were revised due to aseptic loosening. No association was found among the tested parameters with increased revision rates. Three complications associated with the THA were recorded and managed conservatively. All patients had statistically significant improved clinical scores compared to the pre-operative period, despite the underlying disorder that compromised the condition in the majority of the patients. CONCLUSIONS Our study showed excellent long term outcomes of THA in patients younger than 30 years of age, comparable with those in older patients.
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Affiliation(s)
- Emilios E Pakos
- Emilios E. Pakos MD, Nikolaos K. Paschos MD, Theodoros A. Xenakis MD, Laboratory of Orthopaedics and Biomechanics, University of Ioannina, Medical School, Ioannina, Greece
| | - Nikolaos K Paschos
- Emilios E. Pakos MD, Nikolaos K. Paschos MD, Theodoros A. Xenakis MD, Laboratory of Orthopaedics and Biomechanics, University of Ioannina, Medical School, Ioannina, Greece
| | - Theodoros A Xenakis
- Emilios E. Pakos MD, Nikolaos K. Paschos MD, Theodoros A. Xenakis MD, Laboratory of Orthopaedics and Biomechanics, University of Ioannina, Medical School, Ioannina, Greece
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Goodman SM, Mandl LA, Figgie M, Johnson BK, Alexiades M, Ghomrawi H. The use of biologic DMARDs identifies rheumatoid arthritis patients with more optimistic expectations of total knee arthroplasty. HSS J 2014; 10:117-23. [PMID: 25050094 PMCID: PMC4071470 DOI: 10.1007/s11420-014-9380-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/06/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative expectations of total knee arthroplasty (TKA) correlate with postsurgical satisfaction, and are linked to outcomes. Rheumatoid arthritis (RA), and other chronic diseases, may lower expectations, although new biologic medications have greatly enhanced patients' quality of life. QUESTIONS/PURPOSES The purpose of this study is to compare preoperative expectations of RA to those of matched osteoarthritis (OA) patients undergoing TKA, and examine the subset of RA on biologic DMARD therapy. METHODS For a cross-sectional study, RA and OA identified from an institutional TKA registry were matched on age, sex, prior TKA, and preoperative function. Expectations were measured using the Hospital for Special Surgery (HSS) Knee Expectations Survey. Expectations and quality of life measures were assessed preoperatively and scores were compared between RA and OA. RESULTS One hundred fourteen RA cases, 46.5% on biologics, were matched to 228 OA cases. The average expectations score was not significantly lower for RA compared to OA (72.9 ± 20.7 vs. 77.2 ± 18.3, p = 0.040. RA on biologics had expectations similar to OA (total expectation score 76.3 ± 18.1 vs. 77.4 ± 17.4, p = 0.71), while RA not on biologics had expectations that were significantly lower (69.9 ± 22.4 vs. 77.1 ± 19.0, p = 0.03). CONCLUSION Use of biologics in RA patients was associated with higher expectations, similar to those of OA patients, but the effect on outcomes is not known. Further studies should assess the effect of higher expectations in RA patients on outcomes.
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Affiliation(s)
- Susan M. Goodman
- />Division of Rheumatology, Weill Cornell Medical College, New York, NY 10065 USA
- />Division of Rheumatology, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 USA
| | - Lisa A. Mandl
- />Division of Rheumatology, Weill Cornell Medical College, New York, NY 10065 USA
- />Division of Rheumatology, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 USA
| | - Mark Figgie
- />Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10065 USA
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 USA
| | - Beverly K. Johnson
- />Division of Rheumatology, Weill Cornell Medical College, New York, NY 10065 USA
- />Division of Rheumatology, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 USA
| | - Michael Alexiades
- />Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10065 USA
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 USA
| | - Hassan Ghomrawi
- />Division of Health Policy, Weill Cornell Medical College, New York, NY USA
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY USA
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Sugita S, Chikuda H, Kadono Y, Ohtsu H, Takeshita K, Nishino J, Tohma S, Tanaka S. Clinical characteristics of rheumatoid arthritis patients undergoing cervical spine surgery: an analysis of National Database of Rheumatic Diseases in Japan. BMC Musculoskelet Disord 2014; 15:203. [PMID: 24925126 PMCID: PMC4071212 DOI: 10.1186/1471-2474-15-203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 06/06/2014] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this study was to examine the clinical characteristics of rheumatoid arthritis (RA) patients who underwent cervical spine surgery using a multicenter observational database. Methods We obtained data from a nationwide observational cohort database of patients with rheumatic diseases (National Database of Rheumatic Diseases by iR-net in Japan (NinJa)) for the fiscal years 2003 to 2011. A total of 39 out of 60 patients who underwent cervical spine surgery for a RA-related cause and whose data were available for two consecutive years (to assess the preoperative patient status) were chosen as cases. Patients with a non-RA-related cause of surgery (e.g., trauma) were excluded. First, we compared the patient characteristics between the cases and total patients in the same fiscal year. Next, 106 eligible controls, who were defined as RA patients enrolled in the same fiscal year as the case subjects, who were matched for age, gender and disease duration (within ±1 year), were selected. We compared the demographic data between the two groups. We also calculated the percentage of patients who underwent cervical spine surgery (surgeries/total number of patients) in fiscal years 2003 to 2011. Results Although the proportion of patients using biologics linearly increased during study period, the percentage of patients undergoing cervical spine surgeries remained unchanged, at approximately 0.15%. These cases had more tender joints (3 vs. 1, p < 0.01) and exhibited a significantly higher Modified Health Assessment Questionnaire (MHAQ) score (1.13 vs. 0.5, p < 0.01), C-reactive protein (CRP) (1.5 vs. 0.36, p < 0.01), and disease activity score (DAS) 28-CRP (3.63 vs. 2.81, p < 0.01) compared to the controls. Conclusions Our study revealed that RA patients requiring cervical spine surgery have a higher disease activity (as represented by the DAS28-CRP) and are more functionally disabled (as represented by the MHAQ) than control patients.
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Affiliation(s)
- Shurei Sugita
- The Department of Orthopaedic Surgery, The University of Tokyo, Hongo 7-3-1, Bunkyo, Tokyo, Japan.
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Matsumoto T, Nakamura I, Miura A, Momoyama G, Ito K. Radiologic patterning of joint damage to the foot in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2014; 66:499-507. [PMID: 24106167 DOI: 10.1002/acr.22174] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 09/10/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Foot and ankle deformities greatly affect the quality of life of rheumatoid arthritis (RA) patients. The aim of this study was to elucidate the pattern of destruction of the RA foot and its impact on patients. METHODS We cross-sectionally investigated RA patients (274 patients and 542 feet) using radiographs. The grade of joint destruction was assigned using Larsen's grading system for 12 joints in the foot and ankle. Cluster analysis was performed using the K-means method to classify the pattern of joint destruction. Of the 274 patients evaluated radiographically, 212 were assessed for functional disability using questionnaires. RESULTS Cluster analysis revealed that 542 feet were divided into 5 clusters, named according to the characteristic distribution of joint destruction: cluster I (normal type), cluster II (forefoot type), cluster III (midfoot type), cluster IV (mid-hindfoot type), and cluster V (combined type). Radiographic measurements revealed the characteristic deformities of each cluster: splay foot for cluster II, flat foot for cluster III, hindfoot malalignment for cluster IV, and mixtures of these characteristics for cluster V. A distribution map of each cluster based on disease duration revealed that cluster III peaked in cases of 5-10-year disease duration and subsequently decreased, followed by a gradual increase of cluster IV and cluster V. Cluster IV and cluster V showed significant changes in functional disability compared to cluster III. CONCLUSION This report is the first to reveal the pattern of RA foot deformities and their impact on patients using statistical measures in a large series.
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Mäkelä KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin LI, Engesaeter L, Furnes O, Overgaard S, Pedersen AB, Kärrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A. Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database. Acta Orthop 2014; 85:107-16. [PMID: 24650019 PMCID: PMC3967250 DOI: 10.3109/17453674.2014.893498] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/03/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995-2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA database with the Finnish data included. MATERIAL AND METHODS 438,733 THRs performed during the period 1995-2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression, with adjustment for age, sex, and diagnosis, was used to analyze implant survival with revision for any reason as endpoint. RESULTS The 15-year survival, with any revision as an endpoint, for all THRs was 86% (CI: 85.7-86.9) in Denmark, 88% (CI: 87.6-88.3) in Sweden, 87% (CI: 86.4-87.4) in Norway, and 84% (CI: 82.9-84.1) in Finland. Revision risk for all THRs was less in Sweden than in the 3 other countries during the first 5 years. However, revision risk for uncemented THR was less in Denmark than in Sweden during the sixth (HR = 0.53, CI: 0.34-0.82), seventh (HR = 0.60, CI: 0.37-0.97), and ninth (HR = 0.59, CI: 0.36-0.98) year of follow-up. INTERPRETATION The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required.
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Affiliation(s)
- Keijo T Mäkelä
- Department of Orthopaedics and Traumatology , Turku University Hospital
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Bernstein EJ, Mandl LA. Changing incidence of orthopedic surgery in rheumatic disease: contributing factors. Curr Rheumatol Rep 2014; 15:365. [PMID: 23955065 DOI: 10.1007/s11926-013-0365-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Rheumatic diseases are multisystem conditions that predominantly affect the musculoskeletal system, leading to soft tissue and articular damage. Historically, medical therapy was able to slow, but not prevent, erosion and joint destruction, resulting in the frequent need for orthopedic procedures to maintain function and minimize pain. However, the widespread use of disease-modifying anti-rheumatic drugs (DMARDs) and biologic therapy over the last twenty years has resulted in a dramatic decrease in the incidence of musculoskeletal damage and impairment among these patients. This review will discuss changing patterns of orthopedic surgery among patients with rheumatic diseases, focusing on rheumatoid arthritis and systemic lupus erythematosus.
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Affiliation(s)
- Elana J Bernstein
- Division of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA,
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Hekmat K, Jacobsson LT, Nilsson JÅ, Lindroth Y, Turesson C. Changes and sex differences in patient reported outcomes in rheumatoid factor positive RA-results from a community based study. BMC Musculoskelet Disord 2014; 15:44. [PMID: 24552546 PMCID: PMC3932728 DOI: 10.1186/1471-2474-15-44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcomes (PROs) are important measures in rheumatoid arthritis (RA). A register of patients with RA from all rheumatology care providers in Malmö, Sweden, was established in 1997 and has been continually updated. This register includes virtually all the RA patients in the area. The aim of this study was to analyse PROs in surveys of this population conducted between 1997 and 2009, and to assess differences in treatment and outcome in male and female patients. METHOD In 1997, 2002, 2005 and 2009, questionnaires were sent to the RA patients in the register (n = 1016 in 1997; n = 916 in 2002; n = 1625 in 2005; n = 1700 in 2009). Response rates varied between 62 % and 74 %, and 72-74 % was women. Questionnaire data included medication and measures of disability and health related quality of life. Data on rheumatoid factor (RF) tests were retrieved from the databases of the two clinical immunology laboratories in the area. In order to limit the impact of changes in the case mix over time, the study was restricted to RF positive patients. The analyses were stratified by sex. RESULTS Patients reported less severe outcomes for all measures in the later surveys compared to 1997, and patients' global disease activity assessment and self-reported pain were further improved in 2009 compared to 2005. Treatment with biologics increased over time from 1997 (none) to 2009 (29%), with no difference between men and women. Visual analogue scales (0-100) for patients' global assessment of disease activity [mean 45 (95 % CI (45-47) vs. 38 (35-40)] and pain [mean 46 (44-49) vs. 38 (36-40)] decreased from 1997 to 2009, with numerically greater improvement in male patients. The mean SF-36 physical component scores also improved, and were higher in men than in women in all surveys. CONCLUSION Pharmacologic treatment of RA became more extensive over time, and there was improvement in all PROs. Despite similar treatment, male patients reported better outcomes, in particular for pain and physical function, compared to female patients. We suggest that patient reported outcomes should be reported separately in male and female patients with RA.
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Affiliation(s)
- Korosh Hekmat
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Malmö, Sweden.
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Ravi B, Croxford R, Hollands S, Paterson JM, Bogoch E, Kreder H, Hawker GA. Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis. Arthritis Rheumatol 2014; 66:254-63. [DOI: 10.1002/art.38231] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 10/10/2013] [Indexed: 01/04/2023]
Affiliation(s)
| | - Ruth Croxford
- Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Simon Hollands
- Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - J. Michael Paterson
- University of Toronto and Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Earl Bogoch
- University of Toronto and St. Michael's Hospital; Toronto, Ontario Canada
| | - Hans Kreder
- University of Toronto and Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Gillian A. Hawker
- University of Toronto, Institute for Clinical Evaluative Sciences, and Women's College Hospital; Toronto, Ontario Canada
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Somayaji R, Barnabe C, Martin L. Risk factors for infection following total joint arthroplasty in rheumatoid arthritis. Open Rheumatol J 2013; 7:119-24. [PMID: 24454587 PMCID: PMC3893721 DOI: 10.2174/1874312920131210005] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/30/2013] [Accepted: 12/07/2013] [Indexed: 02/08/2023] Open
Abstract
Objectives: Determine risk factors for infection following hip or knee total joint arthroplasty in patients with
rheumatoid arthritis. Methods: All rheumatoid arthritis patients with a hip or knee arthroplasty between years 2000 and 2010 were identified
from population-based administrative data from the Calgary Zone of Alberta Health Services. Clinical data from patient
charts during the hospital admission and during a one year follow-up period were extracted to identify incident infections.
Results: We identified 381 eligible procedures performed in 259 patients (72.2% female, mean age 63.3 years, mean body
mass index 27.6 kg/m2). Patient comorbidities were hypertension (43.2%), diabetes (10.4%), coronary artery disease
(13.9%), smoking (10.8%) and obesity (32%). Few infectious complications occurred: surgical site infections occurred
within the first year after 5 procedures (2 joint space infections, 3 deep incisional infections). Infections of non-surgical
sites (urinary tract, skin or respiratory, n=4) complicated the hospital admission. The odds ratio for any post-arthroplasty
infection was increased in patients using prednisone doses exceeding 15 mg/day (OR 21.0, 95%CI 3.5-127.2, p=<0.001),
underweight patients (OR 6.0, 95%CI 1.2-30.9, p=0.033) and those with known coronary artery disease (OR 5.1, 95%CI
1.3-19.8, p=0.017). Types of disease-modifying therapy, age, sex, and other comorbidities were not associated with an
increased risk for infection. Conclusion: Steroid doses over 15 mg/day, being underweight and having coronary artery disease were associated with
significant increases in the risk of post-arthroplasty infection in rheumatoid arthritis. Maximal tapering of prednisone and
comorbidity risk reduction must be addressed in the peri-operative management strategy.
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Affiliation(s)
- Ranjani Somayaji
- Department of Medicine, Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Health Sciences, University of Calgary, Calgary, Alberta, Canada ; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Liam Martin
- Department of Medicine, Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Adelani MA, Keeney JA, Palisch A, Fowler SA, Clohisy JC. Has total hip arthroplasty in patients 30 years or younger improved? A systematic review. Clin Orthop Relat Res 2013; 471:2595-601. [PMID: 23564363 PMCID: PMC3705054 DOI: 10.1007/s11999-013-2975-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/27/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evolution of total hip arthroplasty (THA) generally has led to improved clinical results. However, THA in very young patients historically has been associated with lower survivorship, and it is unclear whether this, or results pertaining to pain and function, has improved with contemporary THA. QUESTIONS/PURPOSES We performed a systematic review of the English literature on THA in patients 30 years of age and younger to assess changes in (1) indications; (2) implant selection; (3) clinical and radiographic outcomes; and (4) survivorship when comparing contemporary and historical reports. METHODS Multiple databases were searched for articles published between 1965 and 2011 that reported clinical and radiographic outcomes of THA in patients 30 years and younger. Sixteen retrospective case series were identified. Surgical indications, implant selection, clinical and radiographic outcomes, and survivorship of patients undergoing THAs before 1988 were compared with those performed in 1988 and after. RESULTS Reported THAs performed more recently were less likely to be performed for juvenile rheumatoid arthritis than earlier procedures. Cementless fixation became more prevalent in later years. Although clinical outcome scores remained constant, aseptic loosening and revision rates decreased substantially with more contemporary procedures. CONCLUSIONS This review of the literature demonstrates an improvement in radiographic outcomes and survivorship of THA, but no significant differences in pain and function scores, in very young patients treated over the past two decades when compared with historical controls.
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Affiliation(s)
- Muyibat A. Adelani
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - James A. Keeney
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - Allison Palisch
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - Susan A. Fowler
- Becker Medical Library, Washington University School of Medicine, St Louis, MO USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
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Aaltonen KJ, Virkki LM, Jämsen E, Sokka T, Konttinen YT, Peltomaa R, Tuompo R, Yli-Kerttula T, Kortelainen S, Ahokas-Tuohinto P, Blom M, Nordström DC. Do biologic drugs affect the need for and outcome of joint replacements in patients with rheumatoid arthritis? A register-based study. Semin Arthritis Rheum 2013; 43:55-62. [DOI: 10.1016/j.semarthrit.2013.01.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 11/28/2022]
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Jämsen E, Virta LJ, Hakala M, Kauppi MJ, Malmivaara A, Lehto MUK. The decline in joint replacement surgery in rheumatoid arthritis is associated with a concomitant increase in the intensity of anti-rheumatic therapy: a nationwide register-based study from 1995 through 2010. Acta Orthop 2013; 84:331-7. [PMID: 23992137 PMCID: PMC3768029 DOI: 10.3109/17453674.2013.810519] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Drug-based treatment of rheumatoid arthritis (RA) has evolved markedly over the past 2 decades. Using nationwide register data, we studied how this has affected the rates of hip, knee, shoulder, and elbow replacement from 1995 to 2010. METHODS The number of primary joint replacements was obtained from the Finnish Arthroplasty Register. To test the hypothesis that improvements in medical treatment of RA reduce the need for joint replacements, we also collected data about purchases of different disease-modifying anti-rheumatic agents (DMARDs) and biological drugs from the nationwide drug registers. RESULTS The annual incidence of primary joint replacements for RA declined from 19 per 10(5) in 1995 to 11 per 10(5) in 2010. The decline was greater for upper-limb operations than for lower-limb operations. At the same time, the numbers of individuals using methotrexate, hydroxychloroquine, and sulfasalazine (the most commonly used DMARDs) increased 2- to 4-fold. INTERPRETATION Our results are in accordance with observations from other countries, and indicate that the use of joint replacements in RA has decreased dramatically. Our data suggest that effective medical therapy is the most likely explanation for this favorable development.
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Affiliation(s)
- Esa Jämsen
- Coxa, Hospital for Joint Replacement, Tampere,School of Medicine, University of Tampere, Tampere
| | - Lauri J Virta
- Research Department, Social Insurance Institution of Finland, Turku
| | - Markku Hakala
- School of Medicine, University of Tampere, Tampere,Päijät-Häme Central Hospital, Lahti
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