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Li R, Yuan X, Ou Y. Global burden of rheumatoid arthritis among adolescents and young adults aged 10-24 years: A trend analysis study from 1990 to 2019. PLoS One 2024; 19:e0302140. [PMID: 38625989 PMCID: PMC11020938 DOI: 10.1371/journal.pone.0302140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/28/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND In recent decades, there has been a global increase in the burden of rheumatoid arthritis (RA) among adolescents and young adults (AYAs), making it a significant public health issue. However, our understanding of the disease burden, harm, and influencing factors of RA in this population remains insufficient. This study aimed to assess the trends in RA burden among AYAs aged 10-24 years from 1990 to 2019 at the global, regional, and national levels. METHODS Incidence, prevalence, and disability-adjusted life years (DALYs) rate per 100,000 population, as well as average annual percentage changes (AAPCs), of RA among individuals aged 10-24 years were reported globally, regionally, and nationally based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). These global trends were further analyzed by age, sex, and Sociodemographic index (SDI). Joinpoint regression analysis was used to determine the year in which the most significant changes in global trends occurred. RESULTS Globally, the incidence of RA among AYAs increased from 4.98 per 100,000 population in 1990 to 5.41 per 100,000 population in 2019, with an AAPCs of 0.29 (95%CI: 0.26, 0.32, p < 0.001). The most significant increase occurred in 2000, while the most significant decrease occurred in 2014. The prevalence increased from 34.11 per 100,000 population in 1990 to 36.34 per 100,000 population in 2019, with an AAPCs of 0.22 (95%CI: 0.19, 0.24, p<0.001); The most significant increase was observed in 2000, and the most significant decrease occurred in 2014. DALYs rate with RA were 5.96 per 100,000 population in 1990 and 5.79 per 100,000 population in 2019 for AYAs, with an average decrease of 0.1 years per year (AAPCs = -0.1, 95%CI: -0.2, -0.01, p = 0.04). In terms of gender, the incidence, prevalence, and DALYs rate were higher for females compared to males during the same period. Regarding age, the incidence, prevalence, and DALYs rate increased with increasing age. Based on the SDI quintile, the incidence, prevalence, and DALYs rate of RA were highest in countries with high SDI and lowest in countries with low SDI from 1990 to 2019. However, the relationship between incidence and SDI is non-linear. In terms of regions, Tropical Latin America exhibited the highest incidence, prevalence, and DALYs rate, while Andean Latin America experienced the most rapid increase in incidence and prevalence. Southern Latin America saw the fastest growth in DALYs rate, whereas Southern Sub-Saharan Africa witnessed the most significant decline. CONCLUSION In conclusion, the study revealed an overall increase in the incidence and prevalence of RA among adolescents and young adults (AYAs) over the past three decades, while DALYs rate remained relatively stable. Furthermore, the incidence, prevalence, and DALYs rate of RA were found to increase with age. Fortunately, recent proactive preventive measures and treatment methods have shown promising results. Moving forward, it is crucial to prioritize the female population and AYAs patients in order to further alleviate the global burden of RA.
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Affiliation(s)
- Ruibo Li
- Department of Orthopaedics, Deyang Peoples’ Hospita, Deyang, Sichuan, China
- Deyang Clinical College, Chengdu University of Traditional Chinese Medicine, Deyang, Sichuan, China
| | - Xingyue Yuan
- Department of Pathology, Deyang Peoples’ Hospita, Deyang, Sichuan, China
| | - Yili Ou
- Deyang Clinical College, Chengdu University of Traditional Chinese Medicine, Deyang, Sichuan, China
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2
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Nossent J, Keen HI, Preen DB, Inderjeeth CA. Joint surgery rates in lupus: a long-term cohort study. Lupus Sci Med 2024; 11:e001045. [PMID: 38199862 PMCID: PMC10806518 DOI: 10.1136/lupus-2023-001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
AIM With scarce data on the need and type of joint surgery in SLE, we investigated the long-term rates and underlying causes for arthroplasty, arthrodesis and synovectomy in patients with SLE. METHODS Procedure dates for arthroplasty, arthrodesis or synovectomy were retrieved from the state-wide Hospital Morbidity Data Collection between 1985 and 2015 for patients with SLE (n=1855) and propensity-matched controls (n=12 840). Patients with SLE with ≥two additional diagnostic codes for rheumatoid arthritis were classified as rhupus. ORs and incidence rates (IRs) per 100 person-years for joint procedures (JPs) were compared among patients with rhupus, patients with other SLE and controls across three study decades by regression analysis. RESULTS More patients with SLE than controls underwent a JP (11.6% vs 1.3%; OR 10.8, CI 8.86 to 13.24) with a higher IR for JP in patients with SLE (1.9 vs 0.1, rate ratio 19.9, CI 16.83 to 23.55). Among patients with SLE, patients with rhupus (n=120, 60.5%) had the highest odds of arthroplasty (OR 4.49, CI 2.87 to 6.92), arthrodesis (OR 6.64, CI 3.28 to 12.97) and synovectomy (OR 9.02,CI 4.32 to 18.23). Over time, the IR for overall JP in patients with rhupus was unchanged (8.7 to 8.6, R2=0.004, p=0.98), although the IR for avascular necrosis underlying arthroplasty decreased for all patients with SLE (0.52 to 0.10, p=0.02). Patients with other SLE also had significantly higher OR and IR for all three JPs than controls with insignificant decreases in synovectomy and increases in arthroplasty over time in this group. CONCLUSIONS The overall burden of joint surgery in SLE is high and despite a reduction in avascular necrosis, arthroplasty and arthrodesis rates have not decreased over time. These data indicate a need for increased efforts to prevent joint damage in patients with lupus.
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Affiliation(s)
- Johannes Nossent
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Rheumatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Helen Isobel Keen
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Brian Preen
- School of Population & Global Health, The University of Western Australia Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Charles A Inderjeeth
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Rheumatology and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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3
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Takeda R, Matsumoto T, Omata Y, Inui H, Taketomi S, Nagase Y, Nishikawa T, Oka H, Tanaka S. Changes in knee joint destruction patterns among patients with rheumatoid arthritis undergoing total knee arthroplasty in recent decades. Clin Rheumatol 2023; 42:2341-2352. [PMID: 37222908 PMCID: PMC10412667 DOI: 10.1007/s10067-023-06620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES This study aimed to investigate the trend of joint destruction patterns on knee radiographs of patients with rheumatoid arthritis (RA) undergoing total knee arthroplasty (TKA) over the past 16 years. METHOD Medial joint space, lateral joint space, medial spur area, lateral spur area (L-spur), and femoro-tibial angle were obtained from 831 preoperative knee radiographs of patients with RA who underwent TKA between 2006 and 2021 using software capable of automatic measurements. Non-hierarchical clustering was performed based on these five parameters. Trends in the five individual radiographic parameters and the ratio of each cluster were investigated during the target period. Moreover, clinical data from 244 cases were compared among clusters to identify factors associated with this trend. RESULTS All parameters, except for L-spur, showed significant increasing trends from 2006 to 2021. The radiographs were clustered into groups according to the characteristic pattern of radiographic findings: cluster 1 (conventional RA type), with bicompartmental joint space narrowing (JSN), less spur formation, and valgus alignment; cluster 2 (osteoarthritis type), with medial JSN, medial osteophytes, and varus alignment; and cluster 3 (less destructive type), with mild bicompartmental JSN, less spur formation, and valgus alignment. The ratio of cluster 1 showed a significantly decreasing trend contrary to the significantly increasing trend in clusters 2 and 3. The DAS28-CRP of cluster 3 was higher than those of clusters 1 and 2. CONCLUSIONS Radiographs of TKA recipients with RA are increasingly presenting osteoarthritic features in recent decades. Key Points • Using automated measurement software, morphological parameters were measured from radiographs of 831 patients with rheumatoid arthritis who had undergone TKA in the past 16 years. • Cluster analysis based on the radiographic parameters revealed that the radiographs of patients with end-stage knee arthritis requiring total knee arthroplasty were classified into three groups. • In patients with rheumatoid arthritis who have undergone total knee arthroplasty in the past 16 years, the proportion of clusters with features of osteoarthritis and difficult-to-treat rheumatoid arthritis has increased, while the proportion of conventional rheumatoid arthritis has decreased.
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Affiliation(s)
- Ryutaro Takeda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yasunori Omata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuichi Nagase
- Department of Rheumatic Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-city, Tokyo, 183-8524, Japan
| | - Takuji Nishikawa
- Department of Rheumatology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koutoubashi, Sumida-ku, Tokyo, Japan
| | - Hiroyuki Oka
- Department of Clinical Motor System Medicine, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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4
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Brendsdal ES, Lie SA, Furnes O, Hove LM, Krukhaug Y. Long-term survival of 2997 finger metacarpophalanageal joint arthroplasties from the Norwegian Arthroplasty Register. J Hand Surg Eur Vol 2023; 48:3-9. [PMID: 36324068 PMCID: PMC9773006 DOI: 10.1177/17531934221129961] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the long-time survival of 2997 primary metacarpophalangeal (MCP) joint implants from the Norwegian Arthroplasty Register from 1994 to 2019. Six different implants were compared in terms of survival and risk of revision. The majority of implants were inserted in patients diagnosed with inflammatory diseases and in women. The overall survival was found to be 94%, 89%, 85% and 84% after 5, 10, 15 and 20 years. The most prevalent reason for revision was a fractured prosthetic component, and the second was pain. Implants inserted in the right hand and in younger patients had a higher risk for revision. Sex, type of implant, finger treated, one- or two-component prosthesis, and inflammatory or non-inflammatory conditions did not influence the survival. The frequency of MCP joint implantations decreased during the observation period. Our data show satisfactory long-term survival of the MCP implants, with no difference found between implant types or concepts.Level of evidence: II.
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Affiliation(s)
- Eirik S. Brendsdal
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway,Eirik S. Brendsdal, The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Møllendalsbakken 7, 5021 Bergen, Norway.
| | - Stein A. Lie
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Leiv M. Hove
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yngvar Krukhaug
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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5
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Perioperative management of patients with inflammatory rheumatic diseases : Updated recommendations of the German Society for Rheumatology. Z Rheumatol 2023; 82:1-11. [PMID: 35235025 DOI: 10.1007/s00393-021-01150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Prior to surgical interventions physicians and patients with inflammatory rheumatic diseases remain concerned about interrupting or continuing anti-inflammatory medication. For this reason, the German Society for Rheumatology has updated its recommendations from 2014. METHODS After a systematic literature search including publications up to 31 August 2021, the recommendations on the use of of glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics (bDMARDs) were revised and recommendations on newer drugs and targeted synthetic (ts)DMARDs were added. RESULTS The glucocorticoid dose should be reduced to as low as possible 2-3 months before elective surgery (in any case <10 mg/day) but should be kept stable 1-2 weeks before and on the day of surgery. In many cases csDMARDs can be continued, exceptions being a reduction of high methotrexate doses to ≤15 mg/week and wash-out of leflunomide if there is a high risk of infection. Azathioprine, mycophenolate and ciclosporin should be paused 1-2 days prior to surgery. Under bDMARDs surgery can be scheduled for the end of each treatment interval. For major interventions Janus kinase (JAK) inhibitors should be paused for 3-4 days. Apremilast can be continued. If interruption is necessary, treatment should be restarted as soon as possible for all substances, depending on wound healing. CONCLUSION Whether bDMARDs increase the perioperative risk of infection and the benefits and risks of discontinuation remain unclear based on the currently available evidence. To minimize the risk of a disease relapse under longer treatment pauses, in the updated recommendations the perioperative interruption of bDMARDs was reduced from at least two half-lives to one treatment interval.
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6
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Finckh A, Gilbert B, Hodkinson B, Bae SC, Thomas R, Deane KD, Alpizar-Rodriguez D, Lauper K. Global epidemiology of rheumatoid arthritis. Nat Rev Rheumatol 2022; 18:591-602. [PMID: 36068354 DOI: 10.1038/s41584-022-00827-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/09/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease that predominantly affects the joints. The prevalence of RA varies globally, with generally a higher prevalence in industrialized countries, which may be explained by exposures to environmental risk factors, but also by genetic factors, differing demographics and under-reporting in other parts of the world. Over the past three decades, strong trends of the declining severity of RA probably reflect changes in treatment paradigms and overall better management of the disease. Other trends include increasing RA prevalence. Common risk factors for RA include both modifiable lifestyle-associated variables and non-modifiable features, such as genetics and sex. A better understanding of the natural history of RA, and of the factors that contribute to the development of RA in specific populations, might lead to the introduction of specific prevention strategies for this debilitating disease.
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Affiliation(s)
- Axel Finckh
- Division of Rheumatology, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland.
| | - Benoît Gilbert
- Division of Rheumatology, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Bridget Hodkinson
- Division of Rheumatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology and Hanyang University Institute of Bioscience and Biotechnology, Seoul, Republic of Korea
| | - Ranjeny Thomas
- The University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Kevin D Deane
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Kim Lauper
- Division of Rheumatology, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland.,Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
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Increasing trend of radiographic features of knee osteoarthritis in rheumatoid arthritis patients before total knee arthroplasty. Sci Rep 2022; 12:10452. [PMID: 35729263 PMCID: PMC9213507 DOI: 10.1038/s41598-022-14440-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/07/2022] [Indexed: 11/08/2022] Open
Abstract
To investigate the trend and factors related to the occurrence of osteoarthritis (OA)-like features on knee radiographs of rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA) in the recent decades. To classify antero-posterior knee radiographs into 'RA' and 'OA-like RA' groups, a deep learning model was developed by training the network using knee radiographs of end-stage arthropathy in RA patients obtained during 2002-2005 and in primary OA patients obtained during 2007-2009. We used this model to categorize 796 knee radiographs, which were recorded in RA patients before TKA during 2006-2020, into 'OA-like RA' and 'RA' groups. The annual ratio of 'OA-like RA' was investigated. Moreover, univariate and multivariate analyses were performed to identify the factors associated with the classification as OA-like RA using clinical data from 240 patients. The percentage of 'OA-like RA' had significant increasing trend from 20.9% in 2006 to 67.7% in 2020. Higher body mass index, use of biologics, and lower level of C-reactive protein were identified as independent factors for 'OA-like RA'. An increasing trend of knee radiographs with OA-like features was observed in RA patients in the recent decades, which might be attributed to recent advances in pharmacotherapy.
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8
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Tominaga A, Ikari K, Yano K, Tanaka E, Inoue E, Harigai M, Okazaki K. Surgical Intervention for Patients With Rheumatoid Arthritis is Declining Except for Foot and Ankle Surgery: A Single-Center, 20-Year Observational Cohort Study. Mod Rheumatol 2022; 33:509-516. [PMID: 35536604 DOI: 10.1093/mr/roac042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/07/2022] [Accepted: 04/24/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE A global downward trend in the number of rheumatoid arthritis (RA)-related surgeries has been reported. The purpose of our study was to investigate the latest trends in RA-related surgeries in a single-center Japanese RA cohort. METHODS This study was a retrospective analysis of RA-related surgeries between 2001 and 2020 in the Institute of Rheumatology Rheumatoid Arthritis cohort. An average of 4,944 patients per semiannual survey was included in the study. The primary goal was to analyze the half-year period prevalence proportion (HPP) of RA-related surgeries in a 20-year period, and the secondary goal was to analyze the HPP of surgeries by site or by categories of disease activity. RESULTS There has been a downward trend in the HPP of RA-related surgeries in the 20-year study period. The total HPP of RA-related surgeries decreased by 50.3% during the 20-year study period. There was a significant decrease in knee, hip, shoulder/elbow, and hand procedures. Only foot/ankle joint surgeries significantly increased in volume during this period (p=0.001). The HPP of RA-related surgeries remained unchanged in patients with remission or low disease activity. CONCLUSION The number of RA-related surgeries decreased over a 20-year period, but foot/ankle joint surgeries increased in the site-specific evaluation.
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Affiliation(s)
- Ayako Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Eiichi Tanaka
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Masayoshi Harigai
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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9
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Albrecht K, Poddubnyy D, Leipe J, Sewerin P, Iking-Konert C, Scholz R, Krüger K. [Perioperative management of treatment of patients with inflammatory rheumatic diseases : Updated recommendations of the German Society of Rheumatology]. Z Rheumatol 2021; 81:212-224. [PMID: 34928422 DOI: 10.1007/s00393-021-01140-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prior to surgical interventions physicians and patients with inflammatory rheumatic diseases remain concerned about interrupting or continuing anti-inflammatory medication. For this reason, the German Society for Rheumatology has updated its recommendations from 2014. METHODS After a systematic literature search including publications up to 31 August 2021, the recommendations on the use of of glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics (bDMARDs) were revised and recommendations on newer drugs and targeted synthetic (ts)DMARDs were added. RESULTS The glucocorticoid dose should be reduced to as low as possible 2-3 months before elective surgery (in any case <10 mg/day) but should be kept stable 1-2 weeks before and on the day of surgery. In many cases csDMARDs can be continued, exceptions being a reduction of high methotrexate doses to ≤15 mg/week and wash-out of leflunomide if there is a high risk of infection. Azathioprine, mycophenolate and ciclosporin should be paused 1-2 days prior to surgery. Under bDMARDs surgery can be scheduled for the end of each treatment interval. For major interventions Janus kinase (JAK) inhibitors should be paused for 3-4 days. Apremilast can be continued. If interruption is necessary, treatment should be restarted as soon as possible for all substances, depending on wound healing. CONCLUSION Whether bDMARDs increase the perioperative risk of infection and the benefits and risks of discontinuation remain unclear based on the currently available evidence. To minimize the risk of a disease relapse under longer treatment pauses, in the updated recommendations the perioperative interruption of bDMARDs was reduced from at least two half-lives to one treatment interval.
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Affiliation(s)
| | - Denis Poddubnyy
- Rheumatologie am Campus Benjamin Franklin - Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Jan Leipe
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Philipp Sewerin
- Uniklinik Düsseldorf Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, UKD, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Christof Iking-Konert
- Sektion Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Roger Scholz
- Orthopädie und Unfallchirurgie, Collm Klinik Oschatz, Oschatz, Deutschland
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, St.-Bonifatius-Str. 5, 81541, München, Deutschland.
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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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11
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Jiang Q, Fu J, Chai W, Hao LB, Zhou YG, Xu C, Chen JY. Two-stage exchange Arthroplasty is a viable treatment for Periprosthetic joint infection in inflammatory diseases. BMC Musculoskelet Disord 2020; 21:681. [PMID: 33054816 PMCID: PMC7559453 DOI: 10.1186/s12891-020-03701-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, to our best knowledge, few studies have studied the association between inflammatory diseases and subsequent failure after two-stage exchange reimplantation. The aims of this study were to identify the differences in (1) serum markers, synovial indicators and pathology results and (2) treatment outcomes following two-stage exchange arthroplasty between patients with or without inflammatory diseases. Methods A retrospective review of 184 patients with PJI who underwent two-stage revision from 2014 to 2018 was conducted. PJI was diagnosed by using the MSIS criteria. Serum biomarkers, synovial fluid, organism and pathology results at the time of the PJI diagnosis and reimplantation were compared between patients with or without inflammatory diseases. Treatment success was defined according to the Delphi-based consensus criteria; Kaplan-Meier survivorship curves of the patients were generated and compared. Results There was no difference in the biomarkers, pathology results or organism profile at the time of the PJI diagnosis. At reimplantation, the patients with inflammatory diseases generally had higher values of serum markers than those without inflammatory diseases. However, synovial white blood cell count was comparable in patients with inflammatory diseases (1142.8 ± 1385.3*109/mL) and group C (1315.8 ± 1849.3*109/mL, p = 0.841). The total treatment success rate was 91.3% (92% for individuals with inflammatory diseases and 91.2% for the controls). The survivorship of the inflammatory disease group was comparable with that of the control group. Conclusion Two-stage exchange arthroplasty is a viable option for PJIs with inflammatory diseases. Synovial fluid analysis may be less affected by inflammatory diseases than serum markers did in the diagnosis persistent infection at reimplantation.
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Affiliation(s)
- Qiao Jiang
- Medical school of Chinese PLA, General Hospital of People's Liberation Army, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Orthopedic Surgery, The first Medical Center, Chinese PLA General Hospital, Beijing, China.,Medical College, Nankai University, Tianjin, China
| | - Jun Fu
- Department of Orthopedic Surgery, The first Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wei Chai
- Department of Orthopedic Surgery, The first Medical Center, Chinese PLA General Hospital, Beijing, China.,Medical College, Nankai University, Tianjin, China
| | - Li-Bo Hao
- Department of Orthopedic Surgery, The first Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yong-Gang Zhou
- Department of Orthopedic Surgery, The first Medical Center, Chinese PLA General Hospital, Beijing, China.,Medical College, Nankai University, Tianjin, China
| | - Chi Xu
- Department of Orthopedic Surgery, The first Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Ji-Ying Chen
- Medical school of Chinese PLA, General Hospital of People's Liberation Army, No.28 Fuxing Road, Haidian District, Beijing, 100853, China. .,Department of Orthopedic Surgery, The first Medical Center, Chinese PLA General Hospital, Beijing, China. .,Medical College, Nankai University, Tianjin, China.
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12
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Hildebrand AH, Zhang B, Horner NS, King G, Khan M, Alolabi B. Indications and outcomes of radial head excision: A systematic review. Shoulder Elbow 2020; 12:193-202. [PMID: 32565921 PMCID: PMC7285979 DOI: 10.1177/1758573219864305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/16/2019] [Accepted: 06/16/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Radial head excision has historically been a common surgical procedure for the operative management of radial head fractures and post-traumatic conditions. With recent advances in other surgical techniques, controversy exists regarding its indications. This review evaluates the indications and outcomes of radial head excision in traumatic and non-traumatic elbow pathology. METHODS Multiple databases were searched for studies involving radial head excision. Screening and data abstraction were conducted in duplicate. Only studies reporting outcomes for radial head excision were included. RESULTS Twenty-seven studies with 774 radial head excision patients were included. The most common indications involved acute excision of comminuted radial head fractures (n = 347) and rheumatoid arthritis (n = 201). Post-operative functional scores after acute excision were reported to be good to excellent. In the chronic setting of rheumatoid disease, radial head excision resulted in improved range of motion, although pain was not effectively relieved. DISCUSSION Outcomes of radial head excision for acute fracture are good to excellent; however, it should not be performed when concurrent or ligamentous injuries are present. Although some studies compared excision to open reduction and internal fixation or replacement, more data are needed to make proper conclusions. The strength of these conclusions is limited by the quality of included literature.
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Affiliation(s)
| | - Betty Zhang
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Graham King
- Department of Surgery, Western University, London, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Moin Khan, St Joseph’s Healthcare, Hamilton, 50 Charlton Avenue, East Hamilton, Ontario L8N 4A6, Canada.
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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13
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Cordtz R, Hawley S, Prieto-Alhambra D, Højgaard P, Zobbe K, Kristensen LE, Overgaard S, Odgaard A, Soussi BG, Dreyer L. Reduction in Upper Limb Joint Surgery Among Rheumatoid Arthritis Patients: An Interrupted Time-Series Analysis Using Danish Health Care Registers. Arthritis Care Res (Hoboken) 2020; 72:274-282. [PMID: 30680930 DOI: 10.1002/acr.23835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/15/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Joint replacement surgery is a proxy of severe joint damage in rheumatoid arthritis (RA). The aim of this study was to assess the impact of the introduction of biologic disease-modifying antirheumatic drugs (bDMARDs) on the incidence rate (IR) of upper limb joint replacements among newly diagnosed RA patients. METHODS Using the Danish National Patient Register, patients with incident RA from 1996-2012 were identified. Each patient was matched on age, sex, and municipality, with up to 10 general population controls. The age- and sex-standardized 5-year IR per 1,000 person-years of a composite outcome of any first joint replacement of the finger, wrist, elbow, or shoulder was calculated, and an interrupted time-series analysis was undertaken to investigate trends and changes of the IR in the pre-bDMARD (1996-2001) and the bDMARD eras (2003-2012), with a 1-year lag period in 2002. RESULTS In total, 18,654 incident patients with RA were identified (mean age 57.6 years, 70.5% women). The IR of joint replacements among patients with RA was stable at 2.46 per 1,000 person-years (95% confidence interval [95% CI] 1.96, 2.96) from 1996 to 2001 but started to decrease from 2003 onwards (-0.08 per 1,000 person-years annually [95% CI -0.20, 0.02]). Compared with patients with RA, the IR among controls in 1996 was 1/17 and increased continuously throughout the study period. CONCLUSION The IR of upper limb joint replacements started to decrease among patients with RA from 2002 onwards, whereas it increased among controls. Our results suggest an association between the introduction of bDMARDs and a lower need of joint replacements among patients with RA.
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Affiliation(s)
- René Cordtz
- Rigshospitalet-Gentofte, Copenhagen, Denmark, The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - Daniel Prieto-Alhambra
- University of Oxford, Oxford, UK, and Idiap Jordi Gol, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Universitat Autònoma de Barcelona, and Instituto de Salud Carlos III, Barcelona, Spain
| | - Pil Højgaard
- Rigshospitalet-Gentofte, Copenhagen, Denmark, The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Kristian Zobbe
- Rigshospitalet-Gentofte, Copenhagen, Denmark, The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Søren Overgaard
- Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Anders Odgaard
- Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | | | - Lene Dreyer
- Aalborg University and Aalborg University Hospital, Aalborg, Denmark, Rigshospitalet-Gentofte, Copenhagen, Denmark, The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
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14
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Saidane O, Gafsi L, Tekaya AB, Mahmoud I, Tekaya R, Abdelmoula L. Joint Surgery in Tunisian Rheumatoid Arthritis Patients: Prevalence and Risk Factors. Arch Rheumatol 2019; 35:426-434. [PMID: 33458667 PMCID: PMC7788662 DOI: 10.46497/archrheumatol.2020.7483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 10/05/2019] [Indexed: 11/08/2022] Open
Abstract
Objectives
This study aims to assess the prevalence of joint surgery in Tunisian patients with rheumatoid arthritis (RA) and to determine the risk factors of surgical treatment. Patients and methods
This retrospective cross-sectional study was performed over a period of 15 years between January 2000 and December 2014 and included 500 Tunisian patients with RA (78 males, 422 females; mean age 53.4 years; range, 21 to 83 years). The prevalence of joint surgery indication was evaluated. Clinical, paraclinical and therapeutic characteristics of RA were compared according to the need of surgery. Results
Female to male ratio was 5. The indication of joint surgery was noted in 59 patients (12%). Knee joint surgery was the most performed surgical procedure (56% of surgical treatment). A decrease in surgery prevalence from 30% in 2004 to 4% in 2013 was noted. Statistical study showed that factors associated with joint surgery were: delayed diagnosis (p=0.037), long RA duration (p=0.017), young onset of RA (p<0.001), presence of joint deformities (p=0.034), presence of osteoporosis (p=0.029), presence of antinuclear antibodies (p<0.001), combination therapy of methotrexate with other conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) (p=0.001), short period of first medical treatment (p=0.012) and high erythrocyte sedimentation rate (ESR) (p=0.027). In multivariate analysis, three factors were independently related to the use of joint surgery: age at disease onset [odds ratio (OR): 2.799 95% confidence interval (CI): 1.49-5.22; p=0.01], high ESR level (OR: 2.807 95% CI: 1.5-5.24; p=0.01) and association of methotrexate with other csDMARDs (OR: 3.500 95% CI: 1.61-7.56; p=0.01). Conclusion Twelve percent of RA patients needed joint surgical treatment. Predictive factors of surgery were age at disease onset, high ESR level and association of methotrexate with other csDMARDs.
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Affiliation(s)
- Olfa Saidane
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Leila Gafsi
- Department of Rheumatology, Polyclinic El Omrane, Tunis, Tunisia
| | - Aicha Ben Tekaya
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ines Mahmoud
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Rawdha Tekaya
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Leila Abdelmoula
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
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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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Daien C, Hua C, Gaujoux-Viala C, Cantagrel A, Dubremetz M, Dougados M, Fautrel B, Mariette X, Nayral N, Richez C, Saraux A, Thibaud G, Wendling D, Gossec L, Combe B. Update of French society for rheumatology recommendations for managing rheumatoid arthritis. Joint Bone Spine 2019; 86:135-150. [DOI: 10.1016/j.jbspin.2018.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
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Gullick NJ, Ibrahim F, Scott IC, Vincent A, Cope AP, Garrood T, Panayi GS, Scott DL, Kirkham BW. Real world long-term impact of intensive treatment on disease activity, disability and health-related quality of life in rheumatoid arthritis. BMC Rheumatol 2019; 3:6. [PMID: 30886994 PMCID: PMC6390620 DOI: 10.1186/s41927-019-0054-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/25/2019] [Indexed: 12/25/2022] Open
Abstract
Background The emphasis on treating rheumatoid arthritis (RA) intensively reduces disease activity but its impact in routine care is uncertain. We evaluated temporal changes in disease activities and outcomes in a 10-year prospective observational cohort study of patients in routine care at one unit. Methods The Guy’s and St Thomas’ RA cohort was established in 2005. It involved most RA patients managed in this hospital. Clinical diagnoses of RA were made by rheumatologists. Patients were seen regularly in routine care. Each visit included measurement of disease activity scores for 28 joints (DAS28), health assessment questionnaire scores (HAQ) and EuroQol scores. Patients received intensive treatments targeting DAS28 remission. Results In 1693 RA patients mean DAS28 scores fell from 2005 to 15 by 11% from 4.08 (95% CI: 3.91, 4.25) in 2005 to 3.64 (3.34, 3.78); these falls were highly significant (p < 0.001). DAS28 components: swollen joint counts fell by 32% and ESR by 24%; in contrast tender joint counts and patient global assessments showed minimal or no reductions. The reduction in DAS28 scores was predominantly between 2005 and 2010, with no falls from 2011 onwards. Associated with falls in mean DAS28s, patients achieving remission increased (18% in 2005; 27% in 2015) and the number with active disease (DAS28 > 5.1) decreased (25% in 2005; 16% in 2015). In 752 patients seen at least annually for 3 years, persisting remission (68 patients) and intermittent remission (376 patients) were associated with less disability and better health related quality of life. Over time biologic use increased, but they were used infrequently in patients in persistent remission. Conclusions Over 10 years an intensive management strategy in a routine practice setting increased combination DMARD and biologic use: disease activity levels declined; this association is in keeping with a causal relationship. Patients who achieved remission, even transiently, had better functional outcomes than patients never achieving remission. Electronic supplementary material The online version of this article (10.1186/s41927-019-0054-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicola J Gullick
- 1Department of Rheumatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Fowzia Ibrahim
- 2Department of Rheumatology, 3rd Floor, Weston Education Centre, King's College London, Cutcombe Road, London, UK
| | - Ian C Scott
- 3Research Institute for Primary Care & Health Sciences, Primary Care Sciences, Keele University, Keele, Staffordshire UK.,4Department of Rheumatology, Haywood Hospital, High Lane, Burslem, Staffordshire UK.,6Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation, 1st Floor, New Hunt's House, Guy's Campus, King's College London, Great Maze Pond, London, UK
| | - Alexandra Vincent
- 5Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK
| | - Andrew P Cope
- 5Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK.,6Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation, 1st Floor, New Hunt's House, Guy's Campus, King's College London, Great Maze Pond, London, UK
| | - Toby Garrood
- 5Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK
| | - Gabriel S Panayi
- 5Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK
| | - David L Scott
- 2Department of Rheumatology, 3rd Floor, Weston Education Centre, King's College London, Cutcombe Road, London, UK
| | - Bruce W Kirkham
- 5Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK
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Rausch V, Hackl M, Leschinger T, Müller LP, Wegmann K. [Elbow prostheses in rheumatic diseases]. Z Rheumatol 2018; 77:899-906. [PMID: 30255413 DOI: 10.1007/s00393-018-0539-x] [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] [Indexed: 11/24/2022]
Abstract
When the elbow is destroyed due to rheumatic diseases, the joint can be replaced by a prosthesis and total arthroplasty. Improved pharmaceutical treatment for rheumatic diseases has, however, reduced the number of implantations in these patients. Reported 10-year survival rates of the implant currently achieve 81-90%.; however, due to limited long-term survival of the implant and high complication rates, total elbow arthroplasty should still be used with caution. Continuous technical improvements in the available prostheses and in surgical techniques could lead in the future to a decline in complications, such as aseptic loosening and infections.
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Affiliation(s)
- V Rausch
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Schwerpunkt für Unfall‑, Hand- und Ellenbogenchirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - M Hackl
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Schwerpunkt für Unfall‑, Hand- und Ellenbogenchirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - T Leschinger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Schwerpunkt für Unfall‑, Hand- und Ellenbogenchirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Schwerpunkt für Unfall‑, Hand- und Ellenbogenchirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - K Wegmann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Schwerpunkt für Unfall‑, Hand- und Ellenbogenchirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Nystad TW, Husum YS, Furnes ON, Fevang BTS. Incidence and Predictive Factors for Orthopedic Surgery in Patients with Psoriatic Arthritis. J Rheumatol 2018; 45:1532-1540. [DOI: 10.3899/jrheum.180203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the incidence of orthopedic procedures in patients with psoriatic arthritis (PsA), and how patient characteristics, time of diagnosis, and treatment affect the need for surgery.Methods.We reviewed the medical history of 1432 patients with possible PsA at Haukeland University Hospital in Bergen, Norway. There were 590 patients (mean age 49 yrs, 52% women) who had sufficient journal information and a confirmed diagnosis of PsA, and who were included in the present study. Relevant orthopedic procedures were obtained from the hospital’s administrative patient records. Survival analyses were completed to evaluate the effect of different factors such as year of diagnosis, age, sex, radiographic changes, disease activity, and treatment, on the risk of surgery.Results.There were 171 procedures (25% synovectomies, 15% arthrodesis, and 53% prostheses) performed on 117 patients. These factors all increased the risk of surgery: female sex [relative risk (RR) 1.9, p = 0.001], age ≥ 70 years at diagnosis (RR 2.4, p = 0.001), arthritis in initial radiographs (RR 2.2, p = 0.006), and maximum erythrocyte sedimentation rate 30–59 mm/h (RR 1.6, p = 0.026). Time period of diagnosis had no effect on the outcome. In a subanalysis of surgery exclusive of hip and knee arthroplasty, diagnosis in earlier years (1954–1985 vs 1999–2011) was a risk factor (RR 2.1, p = 0.042). Antirheumatic treatment changed significantly over time.Conclusion.There were 20% of patients with PsA who needed surgery. We found that the prognosis of patients with PsA did not change regarding the risk of orthopedic surgery, despite the change in treatment. A possible explanation is the increase in large joint replacements in the general population.
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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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Gualtierotti R, Parisi M, Ingegnoli F. Perioperative Management of Patients with Inflammatory Rheumatic Diseases Undergoing Major Orthopaedic Surgery: A Practical Overview. Adv Ther 2018; 35:439-456. [PMID: 29556907 PMCID: PMC5910481 DOI: 10.1007/s12325-018-0686-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 02/06/2023]
Abstract
Patients with inflammatory rheumatic diseases often need orthopaedic surgery due to joint involvement. Total hip replacement and total knee replacement are frequent surgical procedures in these patients. Due to the complexity of the inflammatory rheumatic diseases, the perioperative management of these patients must envisage a multidisciplinary approach. The frequent association with extraarticular comorbidities must be considered when evaluating perioperative risk of the patient and should guide the clinician in the decision-making process. However, guidelines of different medical societies may vary and are sometimes contradictory. Orthopaedics should collaborate with rheumatologists, anaesthesiologists and, when needed, cardiologists and haematologists with the common aim of minimising perioperative risk in patients with inflammatory rheumatic diseases. The aim of this review is to provide the reader with simple practical recommendations regarding perioperative management of drugs such as disease-modifying anti-rheumatic drugs, corticosteroids, non-steroidal anti-inflammatory drugs and tools for a risk stratification for cardiovascular and thromboembolic risk based on current evidence for patients with inflammatory rheumatic diseases.
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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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Kiadaliri AA, Englund M. Temporal trends and regional disparity in rheumatoid arthritis and gout hospitalizations in Sweden, 1998-2015. Clin Rheumatol 2018; 37:825-830. [PMID: 29359231 PMCID: PMC5835057 DOI: 10.1007/s10067-018-3983-8] [Citation(s) in RCA: 12] [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: 12/21/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 12/05/2022]
Abstract
Hospitalization is an important component of rheumatoid arthritis (RA) and gout economic burden. This study aimed to assess temporal trends and regional disparities in RA and gout hospitalizations among people aged ≥ 20 years in Sweden during 1998–2015. Data on hospital admissions with a principal diagnosis of RA or gout were collected from the National Patient Register. Age-standardized hospitalization rates (ASHRs) were calculated by means of direct standardization. The absolute and relative regional disparities were assessed. The temporal trends in ASHR and proportion of RA and gout hospitalizations from all and musculoskeletal disorders hospitalizations were analyzed using joinpoint regression. Between 1998–2000 and 2013–2015, the ASHR for RA declined by 78.9% from 109.9 to 23.2 per 100,000 Swedish adults, while it almost doubled for gout (from 10.5 to 20.8 per 100,000 Swedish adults). While in 1998–2000, RA hospitalizations were 10.3 times more frequent than gout (0.54 vs 0.05% of all hospitalizations), this ratio declined to 1.1 in 2013–2015 (0.13 vs 0.11% of all hospitalizations). The joinpoint regression revealed that, on average, the ASHR for RA declined by 10.2% (95% CI: 9.3–11.1) per year whereas for gout, it rose by 4.3% (3.2–5.4) per year during 1998–2015. While the relative regional disparities were stable, the absolute regional disparity declined for RA and increased for gout over the study period. While substantial decline in RA hospitalization is encouraging, the substantial rise in gout hospitalization is of concern, reflecting potential increase in prevalence of gout and suboptimal management of the disease.
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Affiliation(s)
- Aliasghar A Kiadaliri
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden.
- Skåne University Hospital, Clinical Epidemiology Unit, Remissgatan 4, SE-221 85, Lund, Sweden.
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
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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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Matsumoto T, Nishino J, Izawa N, Naito M, Hirose J, Tanaka S, Yasui T, Saisho K, Tohma S. Trends in Treatment, Outcomes, and Incidence of Orthopedic Surgery in Patients with Rheumatoid Arthritis: An Observational Cohort Study Using the Japanese National Database of Rheumatic Diseases. J Rheumatol 2017; 44:1575-1582. [PMID: 28864641 DOI: 10.3899/jrheum.170046] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE In this study, we investigated the changes in clinical outcome, treatment, and incidence of orthopedic surgery in patients with rheumatoid arthritis (RA) from 2004 to 2014. METHODS Data were studied from the Japanese nationwide cohort database, NinJa (National Database of Rheumatic Diseases by iR-net in Japan), from 2004 to 2014. The time trends in the incidence of orthopedic procedures were analyzed using linear regression analysis. The cross-sectional annual data were compared between 2004 and 2014 to analyze the changes in clinical outcome and treatment. RESULTS The incidence of orthopedic surgeries in patients with RA consistently decreased from 72.2 procedures per 1000 patients in 2004 to 51.5 procedures per 1000 patients in 2014 (regression coefficient = -0.0028, 95% CI -0.0038 to -0.0019, p < 0.001). The greatest reduction was found in total knee arthroplasty and total hip arthroplasty. Disease activity and functional disability improved significantly over this decade. The proportions of patients receiving methotrexate and biologic disease-modifying antirheumatic drugs significantly increased from 39.6% and 1.7% in 2004 to 63.8% and 27.4% in 2014, respectively. CONCLUSION The overall incidence of orthopedic surgeries in patients with RA significantly decreased, accompanied by improved clinical outcomes because of the expanded use of effective drugs; however, the declining trend differed between procedures or locations. The results from the present study suggest that there might be a change in supply and demand for orthopedic surgeries.
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Affiliation(s)
- Takumi Matsumoto
- From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan. .,T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization.
| | - Jinju Nishino
- From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.,T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
| | - Naohiro Izawa
- From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.,T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
| | - Masashi Naito
- From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.,T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
| | - Jun Hirose
- From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.,T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
| | - Sakae Tanaka
- From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.,T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
| | - Testuro Yasui
- From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.,T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
| | - Koichiro Saisho
- From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.,T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
| | - Shigeto Tohma
- From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.,T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
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Chen YC, Chiu WC, Cheng TT, Lai HM, Yu SF, Su BYJ, Hsu CY, Ko CH, Chen JF. Delayed anti-TNF therapy increases the risk of total knee replacement in patients with severe rheumatoid arthritis. BMC Musculoskelet Disord 2017; 18:326. [PMID: 28764690 PMCID: PMC5540514 DOI: 10.1186/s12891-017-1685-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 07/17/2017] [Indexed: 11/17/2022] Open
Abstract
Background This study evaluated the effect of early anti-tumor necrosis factor (TNF) therapy in patients with severe rheumatoid arthritis (RA) on the subsequent risk of total knee replacement (TKR) surgery. Methods This retrospective observational study included a hospital-based cohort of 200 patients diagnosed with severe RA who received treatment with anti-TNF therapy between 2003 and 2014. Clinical parameters including age, sex, body mass index, and the time from the diagnosis of RA to the initiation of anti-TNF therapy were analyzed. Results Of the 200 enrolled patients, 84 underwent an early intervention (≤3 years from the diagnosis of RA to the initiation of anti-TNF therapy), and 116 underwent a late intervention(>3 years from the diagnosis of RA to the initiation of anti-TNF therapy). Five (6.0%) patients in the early intervention group underwent TKR compared to 31 (26.7%) in the late intervention group (p = 0.023). After adjusting for confounding factors, the late intervention group still had a significantly higher risk of TKR (p = 0.004; odds ratio, 5.572; 95% confidence interval, 1.933–16.062). Those receiving treatment including methotrexate had a lower risk of TKR (p = 0.004; odds ratio, 0.287; 95% confidence interval, 0.122–0.672). Conclusions Delayed initiation of anti-TNF therapy in the treatment of severe RA was associated with an increased risk of TKR surgery. Adding methotrexate treatment decreased the risk of future TKR.
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Affiliation(s)
- Ying-Chou Chen
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan.
| | - Wen-Chan Chiu
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Tien-Tsai Cheng
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Han-Ming Lai
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Shan-Fu Yu
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Ben Yu-Jih Su
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Chung-Yuan Hsu
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Chi-Hua Ko
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Jia-Feng Chen
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
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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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Roberson TA, Bentley JC, Griscom JT, Kissenberth MJ, Tolan SJ, Hawkins RJ, Tokish JM. Outcomes of total shoulder arthroplasty in patients younger than 65 years: a systematic review. J Shoulder Elbow Surg 2017; 26:1298-1306. [PMID: 28209327 DOI: 10.1016/j.jse.2016.12.069] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/15/2016] [Accepted: 12/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite concerns about the longevity of total shoulder arthroplasty (TSA) in young patients, it remains an attractive option because of the absence of superior options. METHODS A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. English-language studies were identified with search terms "total shoulder arthroplasty" (title/abstract) or "shoulder replacement" (title/abstract) and "young" (title/abstract) or "under 65 years of age" (title/abstract). Duplicate studies, studies not reporting outcomes, and those using a humeral resurfacing technique were excluded. Outcomes of interest included pain, range of motion, patient-reported outcome scores, patient satisfaction, radiographic changes, complication and revision rates, and implant survival. RESULTS Six studies met inclusion criteria. Significant improvements in pain, range of motion, and patient-reported outcomes were found across all studies that reported these measures. At an average of 9.4 years, 17.4% underwent revision and 54% had glenoid lucency. Whereas glenoid loosening is the most common reason for revision (52%), overall implant survivorship was reported at 60% to 80% at 10- to 20-year follow-up. Outcome measures including the Constant, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores were reported, with generally satisfactory but not excellent results between 3 and 10 years from surgery. CONCLUSIONS Although there is concern with periprosthetic radiolucency and glenoid loosening in the young patient (<65 years) undergoing TSA, overall low revision rates and high implant survivorship are reported in the current literature. Whereas the patient-reported outcomes are inferior to those of the overall TSA population, there is significant improvement from baseline levels in young patients with glenohumeral arthritis.
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Affiliation(s)
- Troy A Roberson
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA
| | - Jared C Bentley
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA
| | - James T Griscom
- University of South Carolina School of Medicine, Greenville, SC, USA
| | | | - Stefan J Tolan
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA
| | | | - John M Tokish
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
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30
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Tropea J, Brand CA, Bohensky M, Van Doornum S. Myocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis: a retrospective cohort study. Arthritis Res Ther 2016; 18:69. [PMID: 27018019 PMCID: PMC4809028 DOI: 10.1186/s13075-016-0958-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population. In a previous study examining post-MI treatment in RA compared with controls we noted that a higher proportion of the RA patients had experienced MI following a surgical procedure. The aim of this study was to compare the risk of MI and mortality at 6 weeks and 12 months following joint surgery in patients with RA compared with the general population. METHODS Individuals who had undergone joint surgery in Victoria, Australia between 1 July 2000 and 30 June 2007 were identified from routinely collected hospital administrative data. Logistic regression analysis was performed to examine odds of 6 week and 12 month MI and mortality in RA versus non-RA patients with adjustment for age, sex, comorbidities, socioeconomic status, patient type and admission type. Subgroup analysis of total hip and knee arthroplasty episodes was undertaken. RESULTS A total of 308,589 episodes of joint surgery occurred among 240,571 individuals, with 3654 (1.2 %) occurring among patients with RA. At 6 weeks post joint surgery the adjusted odds ratio (OR) for MI was 1.50 (95 % CI 0.96-2.33), all-cause death was 1.85 (95 % CI 1.09-3.13) and cardiovascular death was 1.90 (95 % CI 1.07-3.37). At 12 months post joint surgery the adjusted OR of MI was 1.70 (95 % CI 1.27-2.28), all-cause death was 2.18 (95 % CI 1.66-2.86) and cardiovascular death was 2.30 (95 % CI 1.65-3.22). On analysis of joint surgeries other than hip or knee arthroplasty, people with RA were at greater risk of MI within 6 weeks (adjusted OR 2.32; 95 % CI 1.24-4.34) and 12 months (adjusted OR 2.20; 95 % CI 1.47-3.30) compared to those without RA, but no difference in odds of short term mortality were found. CONCLUSIONS Following an episode of joint surgery RA patients have a significantly increased risk of death at 6 weeks, and MI and death at 12 months, compared to the general population. The reasons for this remain to be elucidated but in the meantime RA patients should be considered at higher risk in the perioperative period.
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Affiliation(s)
- Joanne Tropea
- Melbourne EpiCentre, The Royal Melbourne Hospital and University of Melbourne, Grattan Street, Parkville, VIC, 3050, Australia.
| | - Caroline A Brand
- Melbourne EpiCentre, The Royal Melbourne Hospital and University of Melbourne, Grattan Street, Parkville, VIC, 3050, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Megan Bohensky
- Melbourne EpiCentre, The Royal Melbourne Hospital and University of Melbourne, Grattan Street, Parkville, VIC, 3050, Australia
| | - Sharon Van Doornum
- Melbourne EpiCentre, The Royal Melbourne Hospital and University of Melbourne, Grattan Street, Parkville, VIC, 3050, Australia
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31
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Widdifield J, Moura CS, Wang Y, Abrahamowicz M, Paterson JM, Huang A, Beauchamp ME, Boire G, Fortin PR, Bessette L, Bombardier C, Hanly JG, Feldman D, Bernatsky S. The Longterm Effect of Early Intensive Treatment of Seniors with Rheumatoid Arthritis: A Comparison of 2 Population-based Cohort Studies on Time to Joint Replacement Surgery. J Rheumatol 2016; 43:861-8. [PMID: 26879353 DOI: 10.3899/jrheum.151156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Disease-modifying antirheumatic drugs (DMARD) have the greatest effect when initiated early. We evaluated the influence of early exposure to DMARD on time to joint replacement surgery among patients with incident rheumatoid arthritis (RA). METHOD Using a common protocol, we undertook 2 independent population-based cohort studies of patients with incident RA aged 66 years or older in Ontario (ON) and Quebec (QC) covering the period 2000-2013. We used Cox proportional hazards regression with time-dependent variables measuring duration of drug use in the first year, separately for methotrexate (MTX) and other DMARD, adjusting for baseline demographics, clinical factors, and other potentially confounding drug exposures. Our outcome measure was any joint replacement derived from standardized procedure codes. Adjusted HR and 95% CI were estimated. RESULTS Among 20,918 ON and 6754 QC patients with RA followed for a median of 4.5 years, 2201 and 494 patients underwent joint replacement surgery for crude event rates of 2.0 and 1.4 per 100 person-years, respectively. Greater cumulative exposure to MTX (HR 0.97, 95% CI 0.95-0.98) and other DMARD (HR 0.98, 95% CI 0.97-0.99) in the first year after diagnosis was associated with longer times to joint replacement in ON, corresponding to a 2-3% decrease in the hazard of surgery with each additional month of early use. Similar results were observed in QC. CONCLUSION Greater duration of exposure to DMARD soon after RA diagnosis was associated with delays to joint replacement surgery in both provinces. Early intensive treatment of RA may ultimately reduce demand for joint replacement surgery.
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Affiliation(s)
- Jessica Widdifield
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Cristiano S Moura
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Yishu Wang
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Michal Abrahamowicz
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - J Michael Paterson
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Anjie Huang
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Marie-Eve Beauchamp
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Gilles Boire
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Paul R Fortin
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Louis Bessette
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Claire Bombardier
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - John G Hanly
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Debbie Feldman
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Sasha Bernatsky
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
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Springorum HR, Winkler S, Maderbacher G, Götz J, Baier C, Grifka J, Heers G. [Operative therapy for rheumatoid arthritis of the hand]. Z Rheumatol 2016; 75:69-83; quiz 84-5. [PMID: 26850109 DOI: 10.1007/s00393-016-0046-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The need for operative treatment of severe rheumatic deformities of the hand and wrist is decreasing due to the increased use of disease-modifying drugs; however, some patients do not tolerate or do not sufficiently respond to these drugs, which often results in the hands being affected and in advanced stages to severe deformity and loss of function. In these cases operative surgery can help to slow the progression of rheumatic destruction and restore the function of the patient's hand. This article describes the principles of surgery for rheumatoid arthritis of the hand. A meticulous synovectomy or tenosynovectomy is the first stage of treatment. With progression of rheumatic destruction various salvage procedures are necessary to preserve the best possible functional state.
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Affiliation(s)
- H-R Springorum
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - S Winkler
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - G Maderbacher
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - C Baier
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
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