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Tarallo L, Celli A, Delvecchio M, Costabile L, Ciacca G, Porcellini G, Catani F. Long-term outcomes and trends in elbow arthroplasty with Coonrad-Morrey prosthesis: a retrospective study in large group of patients. INTERNATIONAL ORTHOPAEDICS 2024; 48:2689-2698. [PMID: 39172271 PMCID: PMC11422475 DOI: 10.1007/s00264-024-06272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Total Elbow Arthroplasty (TEA) was first developed to treat severe rheumatoid arthritis, but its uses have grown to encompass end-stage osteoarthritis, post-traumatic arthritis, and distal humeral fractures. This study analyzes indications changes, long-term survival, complications, and post-operative functional results of the Coonrad-Morrey prostheses, enhancing the existing literature on this technique and substantial case history. METHODS We included 122 arthroplasties in 117 patients, 28 males and 89 females (mean age of 67 years) treated in our hospital between 2002 and 2016. Minimum follow-up was four years. We collect functional parameters of 48 patients (51 elbows), due to death of patients due to old age and loss at follow-up. RESULTS Survival rate at five years was 90%, 85% at 10 years and 83% at 15 years. The overall medium Mayo elbow score was 79.7 ± 18.3 with the highest result in osteoarthritis patients (p < 0.005); QuickDASH score was 33.1 ± 25.5 with the worse result in rheumatoid group. Average post-operative arc of motion (ROM) was 95°±27°. There were complications in 46 out of 122 cases (37.7%) and revision surgeries were performed in 12 of them (9.8%): seven aseptic loosening, four late septic loosening, one bushing wear. In 27 instances (22.1%) was reported ulnar nerve involvement. CONCLUSION Coonrad-Morrey prosthesis has shown satisfactory clinical results in the treatment of a wide range of pathologies. The long-term implant survivorship was satisfactory, yet the occurrence of failures and complications cannot be overlooked, above all the ulnar nerve paresthesia. There was a good recovery in quality of life, pain-free with limited residual limb disability.
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Affiliation(s)
- Luigi Tarallo
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
| | - Andrea Celli
- Department of Orthopaedics and Traumatology, Hesperia Hospital, Modena, Italy
| | - Matilde Delvecchio
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Lorenzo Costabile
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Grazia Ciacca
- Department of Orthopaedics and Traumatology, Hesperia Hospital, Modena, Italy
| | - Giuseppe Porcellini
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Mihalopoulos M, Okewunmi J, Stern BZ, Huang HH, Galatz LM, Poeran J, Moucha CS. Did the Comprehensive Care for Joint Replacement Bundled Payment Program Impact Sex Disparities in Total Hip and Knee Arthroplasties? J Arthroplasty 2024; 39:1226-1234.e4. [PMID: 37972665 DOI: 10.1016/j.arth.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sex disparities have been noted across various aspects of total hip/knee arthroplasty (THA/TKA). Given incentives to standardize care, bundled payment initiatives including the Comprehensive Care for Joint Replacement (CJR) program may reduce disparities. This study aimed to assess the CJR program's impact on sex disparities in THA/TKA care and outcomes. METHODS This retrospective cohort study included 259,673 THAs (61.7% women) and 506,311 TKAs (64.0% women) from a large national database (2013 to 2017). Sex disparities were assessed for care and outcomes related to the period (1) before surgery, (2) during hospitalization for THA/TKA, and (3) after discharge. Disparities were reported as women:men ratios. Difference-in-differences analyses estimated the impact of the CJR program on pre-existing sex disparities. RESULTS For both THA and TKA, women were less likely than men to present with a Charlson-Deyo comorbidity index >0 (women:men ratio 0.88 to 0.92), but were more likely to require blood transfusions (women:men ratio 1.48 to 1.79) and be discharged to institutional postacute care (women:men ratio 1.50 to 1.66). Difference-in-differences models demonstrated that the CJR bundled payment program reduced sex disparities in institutional postacute care discharges (THA: -2.28%; 95% confidence interval [CI] -4.20 to -0.35%, P = .02; TKA: -2.07%; 95% CI -3.93 to -0.20%; P = .03) and THA 90-day readmissions (-1.00%, 95% CI -1.88 to -0.13%, P = .02), indicating a differential impact of CJR in women versus men for some outcomes. CONCLUSIONS While sex disparities in THA/TKA persist, the CJR program demonstrates potential to impact such differences. Future research should focus on how potential mechanisms could be leveraged to reduce disparities.
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Affiliation(s)
- Meredith Mihalopoulos
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey Okewunmi
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brocha Z Stern
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hsin-Hui Huang
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jashvant Poeran
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Calin S Moucha
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Walker D. 45 years in rheumatology. Rheumatology (Oxford) 2024; 63:904-905. [PMID: 37935418 DOI: 10.1093/rheumatology/kead589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Affiliation(s)
- David Walker
- Department of Rheumatology, North Tyneside General Hospital, North Shields, UK
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David P, Di Matteo A, Hen O, Dass S, Marzo-Ortega H, Wakefield RJ, Bissell LA, Nam J, Mankia K, Emery P, Saleem B, McGonagle D. Poly-Refractory Rheumatoid Arthritis: An Uncommon Subset of Difficult to Treat Disease With Distinct Inflammatory and Noninflammatory Phenotypes. Arthritis Rheumatol 2024; 76:510-521. [PMID: 38059326 DOI: 10.1002/art.42767] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/09/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To investigate the prevalence of poly-refractory rheumatoid arthritis (RA) defined as failure of all biological (b)/targeted synthetic (ts)-disease-modifying drugs (DMARDs). To further investigate whether patients with persistent inflammatory refractory RA (PIRRA) and noninflammatory refractory RA (NIRRA), determined by objective ultrasound (US) synovitis, have distinct clinical phenotypes in both EULAR difficult-to-treat RA (D2T-RA) and poly-refractory RA groups. METHODS A cross-sectional study of 1,591 patients with RA on b/tsDMARDs that evaluated D2T-RA criteria and subclassified as poly-refractory if inefficacy/toxicity to at least one drug of all classes. PIRRA was defined if US synovitis in one or more swollen joint and NIRRA if absent. Univariate tests and multivariate logistic regression were conducted to investigate factors associated with poly-refractory, PIRRA, and NIRRA phenotypes. RESULTS 122 of 1,591 were excluded due to missing data. 247 of 1,469 (16.8%) had D2T-RA and only 40 of 1,469 (2.7%) poly-refractory RA. This latter group had higher disease activity score 28 C-reactive protein (CRP) (median 5.4 vs 5.02, P < 0.05), CRP levels (median 13 vs 5 mg/l, P < 0.01), and smoking (ever) rates (20% vs 4%, P < 0.01) compared with other D2T patients. Smoking was associated with poly-refractory RA (odds ratio 5.067, 95% CI 1.774-14.472, P = 0.002). Of 107 patients with D2T-RA with recent US, 61 (57%) were PIRRA and 46 (43%), NIRRA. Patients with NIRRA had elevated body mass index (median 30 vs 26, P < 0.001) and higher fibromyalgia prevalence (15% vs 3%, P < 0.05), lower swollen joint count (median: 2 vs 5, P < 0.001), and lower CRP levels (5 vs 10, P < 0.01). CONCLUSION Only 2.7% of D2T-RA failed all classes of b/tsDMARDs. Among D2T-RA, less than 60% had objective signs of inflammation, representing a target for innovative strategies.
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Affiliation(s)
- Paula David
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Sheba Medical Center- Tel Hashomer, Ramat Gan, Israel
| | - Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Or Hen
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Sheba Medical Center- Tel Hashomer, Ramat Gan, Israel
| | - Shouvik Dass
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Jacqueline Nam
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Benazir Saleem
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Deng C, Chiu KHY, Lou N, Xing F. Case report: Occult Listeria monocytogenes invasion leading to prosthetic hip joint infection in a patient with rheumatoid arthritis taking tofacitinib. Front Med (Lausanne) 2024; 10:1322993. [PMID: 38264038 PMCID: PMC10803402 DOI: 10.3389/fmed.2023.1322993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] Open
Abstract
It has been suggested that targeted therapy may potentially increase the risk of listeriosis. However, no reported cases of Listeria monocytogenes prosthetic joint infection have been documented during Janus Kinase (JAK) pathway inhibitor use. Herein, we present a 70-year-old female with rheumatoid arthritis who had undergone bilateral hip joint replacement and subsequently developed Listeria monocytogenes prosthetic joint infection following tofacitinib therapy. We suggest that the use of tofacitinib may potentially heighten susceptibility to listeriosis in patients afflicted with rheumatoid arthritis.
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Affiliation(s)
- Chaowen Deng
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | | | - Nan Lou
- Department of Orthopedics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Fanfan Xing
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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Zhang AR, Cheng QH, Yang YZ, Yang X, Zhang ZZ, Guo HZ. Meta-analysis of outcomes after total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis. Asian J Surg 2024; 47:43-54. [PMID: 37777403 DOI: 10.1016/j.asjsur.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/27/2023] [Accepted: 09/06/2023] [Indexed: 10/02/2023] Open
Abstract
The purpose of this study was to compare the difference in functional scores and the incidence of complications after TKA between RA and osteoarthritis. The PubMed, MedLine, The Cochrane Library, Embase and Web of Science databases were searched for all clinical studies up to 15 March 2023 comparing outcomes after total knee replacement in patients with RA and OA, with two review authors independently screening the literature. A total of 7,820,115 (knee-counted) cases were included in 34 studies. The results of meta-analysis showed that the scores of the RA group were lower than that of the osteoarthritis group in the postoperative knee joint score [MD=-2.72,95%CI(-5.06,-0.38),P=0.02] and the postoperative knee joint function score [MD=-11.47,95%CI(-16.55,-6.39),P<0.00001], and the difference was statistically significant. The incidence of deep venous thrombosis (OR=0.84,95%CI(0.79,0.90),P<0.00001) and pulmonary embolism (OR=0.84,95%CI(0.78,0.91),P<0.00001) were significantly lower in RA than in osteoarthritis (P<0.00001). Compared with patients with osteoarthritis, patients with rheumatoid arthritis have lower knee society scores and functional scores after total knee arthroplasty, and a higher risk of prosthetic infection, loosening, and revision, but TKA can still effectively reduce pain in RA patients, Improve function and quality of life without increasing the risk of lower extremity venous thrombosis and pulmonary embolism. Therefore, total knee replacement can be used as a treatment option for patients with rheumatoid arthritis who have not responded to conservative treatment. Patients should fully understand the benefits and possible risks of total knee replacement and develop an individualized treatment plan.
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Affiliation(s)
- An-Ren Zhang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China.
| | | | - Yong-Ze Yang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China
| | - Xin Yang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China
| | - Zhuang-Zhuang Zhang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China
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Arora D, Taneja Y, Sharma A, Dhingra A, Guarve K. Role of Apoptosis in the Pathogenesis of Osteoarthritis: An Explicative Review. Curr Rheumatol Rev 2024; 20:2-13. [PMID: 37670694 DOI: 10.2174/1573397119666230904150741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/29/2023] [Accepted: 07/20/2023] [Indexed: 09/07/2023]
Abstract
Apoptosis is a complex regulatory, active cell death process that plays a role in cell development, homeostasis, and ageing. Cancer, developmental defects, and degenerative diseases are all pathogenic disorders caused by apoptosis dysregulation. Osteoarthritis (OA) is by far the most frequently diagnosed joint disease in the aged, and it is characterized by the ongoing breakdown of articular cartilage, which causes severe disability. Multiple variables regulate the anabolic and catabolic pathways of the cartilage matrix, which either directly or indirectly contribute to cartilage degeneration in osteoarthritis. Articular cartilage is a highly specialized tissue made up of an extracellular matrix of cells that are tightly packed together. As a result, chondrocyte survival is crucial for the preservation of an optimal cartilage matrix, and chondrocyte characteristics and survival compromise may result in articular cartilage failure. Inflammatory cytokines can either promote or inhibit apoptosis, the process of programmed cell death. Pro-apoptotic cytokines like TNF-α can induce cell death, while anti-apoptotic cytokines like IL-4 and IL-10 protect against apoptosis. The balance between these cytokines plays a critical role in determining cell fate and has implications for tissue damage and disease progression. Similarly, they contribute to the progression of OA by disrupting the metabolic balance in joint tissues by promoting catabolic and anabolic pathways. Their impact on cell joints, as well as the impacts of cell signalling pathways on cytokines and inflammatory substances, determines their function in osteoarthritis development. Apoptosis is evident in osteoarthritic cartilage; however, determining the relative role of chondrocyte apoptosis in the aetiology of OA is difficult, and the rate of apoptotic chondrocytes in osteoarthritic cartilage is inconsistent. The current study summarises the role of apoptosis in the development of osteoarthritis, the mediators, and signalling pathways that trigger the cascade of events, and the other inflammatory features involved.
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Affiliation(s)
- Deepshi Arora
- Department of Pharmacy, Guru Gobind Singh College of Pharmacy, Yamuna Nagar, Haryana, 135001, India
| | - Yugam Taneja
- Zeon Lifesciences, Paonta Sahib, Himachal Pradesh, 173025, India
| | - Anjali Sharma
- Department of Pharmacy, Guru Gobind Singh College of Pharmacy, Yamuna Nagar, Haryana, 135001, India
| | - Ashwani Dhingra
- Department of Pharmacy, Guru Gobind Singh College of Pharmacy, Yamuna Nagar, Haryana, 135001, India
| | - Kumar Guarve
- Department of Pharmacy, Guru Gobind Singh College of Pharmacy, Yamuna Nagar, Haryana, 135001, India
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Holzapfel DE, Thieme M, Kappenschneider T, Holzapfel S, Maderbacher G, Weber M, Grifka J, Meyer M. [Outcome of joint replacement in patients with underlying rheumatoid disease]. Z Rheumatol 2023; 82:825-833. [PMID: 37792031 PMCID: PMC10695889 DOI: 10.1007/s00393-023-01424-4] [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] [Accepted: 07/14/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Artificial joint replacement is a meaningful treatment option for patients with advanced rheumatic degenerative joint diseases. The aim of this study was to investigate the influence of the underlying rheumatic diseases on postoperative complications and patient-reported outcome (PRO) after elective total joint replacement (TJR). MATERIAL AND METHODS In a retrospective analysis of 9149 patients with elective total knee or total hip arthroplasty (TKR and THR), complication rates and PRO of patients with and without rheumatic diseases (RD) were compared. Multivariate logistic regression models were used to determine whether the underlying rheumatic disease was an independent risk factor for various complications. RESULTS In the univariate analyses the RD patients had an increased risk of medical complications (7.1% vs. 5.2%; p = 0.028) and Clavien-Dindo grade IV complications (2.8% vs. 1.8%; p = 0.048) after TJR. This was confirmed in multivariate statistical analyses (p < 0.034). The rates for operative revisions and surgical complications were comparable (2.5% vs. 2.4%; p = 0.485). Analysis of the PRO showed a higher responder rate in patients with RD after TKR (91.9% vs. 84.5%, p = 0.039). In contrast, the responder rate in patients with RD after THR was comparable (93.4% vs. 93.2%, p = 0.584). CONCLUSION Despite increased postoperative complication rates, patients with underlying rheumatic diseases showed a comparable outcome 1 year after TJR. After TKR the RD patients showed even higher responder rates. Although RD patients are a vulnerable patient group, they can still benefit from joint replacement.
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Affiliation(s)
- Dominik Emanuel Holzapfel
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - Max Thieme
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Tobias Kappenschneider
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Sabrina Holzapfel
- Department of Neonatology, Children's Hospital St. Hedwig Barmherzige Brüder, Medical Center, Regensburg, Deutschland
| | - Günther Maderbacher
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Markus Weber
- Center of Oncology, Hospital Barmherzige Brüder, Medical Center, Regensburg, Deutschland
| | - Joachim Grifka
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Matthias Meyer
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
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Ntourantonis D, Lianou I, Iliopoulos I, Pantazis K, Korovessis P, Panagiotopoulos E. Static Baropodometry for Assessing Short-Term Functional Outcome after Unilateral Total Knee Arthroplasty: Exploring Correlation between Static Plantar Pressure Measurements and Self-Reported Outcomes. J Clin Med 2023; 12:6917. [PMID: 37959381 PMCID: PMC10650917 DOI: 10.3390/jcm12216917] [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: 07/18/2023] [Revised: 09/15/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
This study aimed to investigate the association between objective baropodometric and radiological measurements and patient self-reported functional outcomes, assessed through the Knee Injury and Osteoarthritis Outcome Score (KOOS). Additionally, it sought to evaluate the effectiveness of static baropodometry in predicting short-term KOOS results following unilateral total knee arthroplasty (TKA). We conducted a prospective single-center study involving 32 patients who underwent unilateral TKA for knee osteoarthritis (KOA). Patients were evaluated both preoperatively and six months postoperatively, utilizing objective measurements derived from static baropodometric analysis in a normal, relaxed, bipedal standing position using a multi-platform Plantar Pressure Analysis System (PPAS) and radiographic measurements of the femorotibial angle (FTA) and subjective assessments through the national validated version of the KOOS. The study found an insignificant average correction of -0.69° ± 4.12° in the preoperative FTA at the sixth month after TKA. Moreover, there were no significant differences in the KOOS based on different types of knee alignment (KA) both pre- and postoperatively (p > 0.05). No significant correlations were observed between the KOOS, and total average affected and unaffected plantar pressures (TAAPP and TAUPP) pre- and postoperatively, as well as KA pre- and postoperatively. However, significant changes were observed in TAAPP and TAUPP measurements after unilateral TKA. TAAPP demonstrated a significant increase postoperatively (mean change (SD) = 18.60 (47.71); p = 0.035). In conclusion, this study found no significant correlation between KA, static baropodometric measurements, including pre- and postoperative differences, and KOOS outcomes. Therefore, static plantar pressure measurements alone might not serve as a reliable predictor of short-term clinical outcomes after unilateral TKA, as reported by patients.
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Affiliation(s)
- Dimitrios Ntourantonis
- Emergency Department, University Hospital of Patras, 26504 Patras, Greece
- Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Ioanna Lianou
- Department of Orthopaedics, General Hospital of Patras, 26332 Patras, Greece; (I.L.)
| | - Ilias Iliopoulos
- Department of Orthopaedics, Aimis Healthcare Group, Larnaca 6309, Cyprus;
| | | | - Panagiotis Korovessis
- Department of Orthopaedics, General Hospital of Patras, 26332 Patras, Greece; (I.L.)
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Ahiarakwe U, Zachary Pearson, Ochuba A, Kim W, Pressman Z, Haft M, Srikumaran U, Best MJ. Trends in total elbow arthroplasty in patients with rheumatoid arthritis receiving disease-modifying antirheumatic drug therapy based on payer status. J Shoulder Elbow Surg 2023; 32:2132-2139. [PMID: 37348781 DOI: 10.1016/j.jse.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Total elbow arthroplasty (TEA) is often used to manage advanced arthropathies of the elbow caused by inflammatory conditions such as rheumatoid arthritis (RA). Recent literature has shown that use of TEA is decreasing in patients with RA, part of which can be attributed to early medical management involving disease-modifying antirheumatic drugs (DMARDs). However, there is a significant economic barrier to accessing DMARD therapy. The purpose of this study was to compare the use of TEA between patients with and without DMARD therapy from 2010 to 2020. METHODS A retrospective cohort analysis was performed using a national insurance claim database to investigate the trends of patients with RA undergoing TEA from 2010-2020. Patients who underwent TEA and had a diagnosis of RA were identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD)-9 and ICD-10 codes between 2010 and 2020. These patients were then stratified into 2 cohorts: those with DMARD prescription claims and those without. A linear regression, compound annual growth rate (CAGR) analysis, and χ2 analysis were conducted to compare trends and demographic variables, including insurance type, between cohorts. Additionally, a multivariable logistic regression was subsequently performed to observe odds ratios (ORs) and 95% confidence intervals. RESULTS From 2010 to 2020, there has been no significant change in the incidence of TEA in RA patients without DMARD prescriptions, whereas there has been a statistically significantly decreasing rate of TEA observed in RA patients with DMARD prescription claims. The analysis showed that there was a CAGR of -4%. For patients with a diagnosis of RA and DMARD prescription claims, the highest incidence of undergoing TEA was seen in the age group of 60-69 years, whereas patients with a diagnosis of RA and no DMARD prescription claims had the highest incidence of undergoing TEA in the age group of 70-79 years. CONCLUSION The incidence of patients undergoing TEA with a diagnosis of RA and DMARD prescription claims has shown a statistically significant decrease from 2010 to 2020, whereas no significant difference was observed for patients without DMARD prescription claims. There were no statistically significant differences in the insurance plans between cohorts.
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Affiliation(s)
- Uzoma Ahiarakwe
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA; Department of Orthopaedic Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Zachary Pearson
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - Arinze Ochuba
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - William Kim
- Department of Orthopaedic Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Zachary Pressman
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - Mark Haft
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
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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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12
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Umemoto A, Ito H, Azukizawa M, Murata K, Tanaka M, Fujii T, Onishi A, Onizawa H, Ishie S, Murakami A, Nishitani K, Murakami K, Yoshitomi H, Hashimoto M, Morinobu A, Matsuda S. How do symptoms of each joint contribute to global pain, disease activity and functional disability in rheumatoid arthritis?-A comprehensive association study using a large cohort. PLoS One 2023; 18:e0285227. [PMID: 37624815 PMCID: PMC10456163 DOI: 10.1371/journal.pone.0285227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Established assessment tools for patients with rheumatoid arthritis (RA), including disease activity scores (DASs), disease activity indexes (DAIs), visual analog scales (VASs), and health assessment questionnaires (HAQs), are widely used. However, comparative associations between joint involvement and disease status assessment tools have rarely been investigated. METHODS We included a dataset of 4016 patients from a large RA cohort from 2012 to 2019. The tenderness and swelling of each joint were counted as a symptom, with 70 and 68 affected joints throughout the body, respectively. The relative contribution of various joints to the disease status assessment tools, VAS scores, and functional disability indexes was analyzed using multiple regression analysis. RESULTS The wrist showed the most significant contribution overall, especially in DASs and VASs, while the metacarpophalangeal and proximal interphalangeal joints made significant contributions to DASs and DAIs, but not to VASs and HAQs. The shoulder and the elbow significantly contributed to HAQs, but only the shoulder did to the VASs. The knee universally contributed to all of the tools, but the ankle played a minor but important role in most assessment tools, especially in HAQs. Similar but different contribution ratios were found between the sets of DASs, DAIs, VASs, or HAQs. CONCLUSIONS Each joint makes a unique contribution to these assessment tools. The improvement or aggravation of symptoms in each joint affects the assessment tools in different manners.
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Affiliation(s)
- Akio Umemoto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masayuki Azukizawa
- Department of Orthopaedic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Fujii
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Onishi
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideo Onizawa
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Ishie
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akinori Murakami
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroyuki Yoshitomi
- Department of Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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13
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Wang X, Zhang L, Li H, Bian T, Zhou Y, Li Y. Predisposing factors for allogeneic blood transfusion in patients with rheumatoid arthritis undergoing primary unilateral total knee arthroplasty. Front Surg 2023; 10:1205896. [PMID: 37560315 PMCID: PMC10407091 DOI: 10.3389/fsurg.2023.1205896] [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: 04/14/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND To determine the incidence and identify the predisposing factors for allogeneic blood transfusion (ABT) in patients with rheumatoid arthritis (RA) undergoing primary unilateral total knee arthroplasty (TKA). METHODS A total of 702 patients with RA who underwent primary unilateral TKA between 2003 and 2022 at a single center, were retrospectively enrolled. Patients were stratified into the ABT and non-ABT groups. Data on patient demographics, laboratory parameters, and disease- and surgery-related parameters were collected from chart reviews and compared between the ABT and non-ABT groups. Multivariate logistic regression analysis was conducted to identify the possible factors associated with postoperative ABT. RESULTS A total of 173 (24.6%) patients underwent ABT after surgery. Significant risk factors for ABT included the degree of flexion contracture [odds ratio (OR) = 1.018, P = 0.005] and thickness of insertion (OR = 1.170, P = 0.014). Conversely, body mass index (OR = 0.937, P = 0.018), preoperative hemoglobin level (OR = 0.973, P < 0.001), and intraoperative use of tranexamic acid (TXA) (OR = 0.119, P < 0.001) were associated with a lower risk of ABT in TKA. CONCLUSION We identified the significant risk and protective factors for ABT during TKA in patients with RA. This information could be helpful in optimizing perioperative blood management strategies during these surgeries.
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Affiliation(s)
- Xiaolin Wang
- Department of Anesthesiology, Beijing Jishuitan Hospital, Capital Medical University, the Fourth Clinical College of Peking University, Beijing, China
| | - Liang Zhang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, the Fourth Clinical College of Peking University, Beijing, China
| | - Hongchao Li
- Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Capital Medical University, the Fourth Clinical College of Peking University, Beijing, China
| | - Tao Bian
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, the Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, the Fourth Clinical College of Peking University, Beijing, China
| | - Yujun Li
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, the Fourth Clinical College of Peking University, Beijing, China
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14
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Yoon HK, Seok SO, Oh HC, Ha JW, Park S, Park SH. Joint Replacement Surgery in Patients with Rheumatoid Arthritis in South Korea: Analysis of a Large National Database. Clin Orthop Surg 2023; 15:395-401. [PMID: 37274496 PMCID: PMC10232310 DOI: 10.4055/cios21274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND We aimed to investigate the current trend of joint replacement surgery incidence in patients with rheumatoid arthritis (RA) in South Korea and to compare the incidence of joint replacement surgery in each affected joint. METHODS We performed this big data analysis to investigate the current trend of joint replacement surgery incidence in patients with RA in South Korea and to compare the incidence of joint replacement surgery in each affected joint. This retrospective study was based on data from the Korea National Health Insurance claims database. RESULTS The prevalence of RA increased every year (0.13% in 2008, 0.25% in 2016). The number of newly diagnosed patients increased from 29,184 in 2010 to 38,347 in 2016. The incidence rate of joint replacement surgery in patients with RA increased from 0.72% in 2010 to 4.03% in 2016. The knee (68.3%) was the most commonly replaced joint. The relative risk (RR) of additional joint replacement surgery was highest for the shoulder joint (RR,1.454; 95% confidence interval, 0.763-2.771). The median time from diagnosis to surgery was the shortest in the elbow joint (379 days) and the longest in the shoulder joint (955 days). The median time for each joint was short in order of the elbows, ankles, hips, knees, and shoulders (p < 0.01). CONCLUSIONS The most frequently and initially replaced joints were different, but the prevalence and incidence of RA, as well as those of joint replacement surgery, have recently increased in South Korea. Joint replacement surgery in RA was the highest for the knee joint. The median time from diagnosis to surgery was shortest for the elbow, followed by the ankle, hip, knee, and shoulder. Regardless of whether patients are symptomatic, evaluation of large joints such as the knee, elbow, ankle, and hip should be considered from an early stage.
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Affiliation(s)
- Han-Kook Yoon
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Ok Seok
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun-Cheol Oh
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Joong-Won Ha
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sunghun Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hoon Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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15
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Ciofoaia EI, Pillarisetty A, Constantinescu F. Health disparities in rheumatoid arthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221137127. [PMID: 36419481 PMCID: PMC9677290 DOI: 10.1177/1759720x221137127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/12/2022] [Indexed: 10/20/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint inflammation that involves symmetric polyarthritis of small and large joints. Autoimmune rheumatic diseases represent a significant socioeconomic burden as they are among the leading causes of death and morbidity due to increased risk of cardiovascular disease. Health disparities in patients with rheumatoid arthritis affect outcomes, prognosis, and management of the disease.
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Affiliation(s)
- Elena I. Ciofoaia
- Division of Rheumatology, MedStar/Georgetown
Washington Hospital Center, Washington, DC, USA
| | - Anjani Pillarisetty
- Division of Rheumatology, MedStar/Georgetown
Washington Hospital Center, Washington, DC, USA
| | - Florina Constantinescu
- Division of Rheumatology, MedStar/Georgetown
Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010,
USA
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16
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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: 88] [Impact Index Per Article: 44.0] [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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17
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Ying Y, Tang Z, Niu F, Xu T, Xia C, Zhang S. Network pharmacology-based pharmacological mechanism prediction on Eucommia ulmoides against rheumatoid arthritis. Medicine (Baltimore) 2022; 101:e29658. [PMID: 35866805 PMCID: PMC9302290 DOI: 10.1097/md.0000000000029658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Rheumatoid arthritis (RA) is a common chronic autoimmune disease characterized by synovial inflammation and progressive joint destruction. Eucommia ulmoides (EU) is a kidney-tonifying Chinese medicine that has been applied to treat RA for decides. The present study aims to explore pharmacological mechanisms of EU against RA using network pharmacology approach. Traditional Chinese Medicine Systems Pharmacology (TCMSP) database was used to screen active ingredients of EU, and their relative targets were fished from UniProt database. RA-related targets were screened from GeneCards database and DisGeNET database. The overlapping genes between EU and RA were identified by Venn diagram, and further analyzed for protein-protein interaction (PPI), Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG). Fifty active ingredients were identified in EU, and corresponded to 207 targets. Meanwhile, 499 targets were closely associated with RA development. A total of 50 overlapping genes between EU and RA were identified, which were regarded as therapeutically relevant. GO enrichment analysis indicated that EU exerted antiRA effects depending on regulating multiple biological processes including inflammatory response, oxidative stress, cell apoptosis and matrix catabolism. Several key pathways such as TNF pathway, IL-17 pathway, T cell receptor pathway, NOD-like receptor pathway and Toll-like receptor pathway, were involved in the above biological processes. Network pharmacology revealed that EU exerts therapeutic effects on RA through multi-ingredients, multi-targets and multi-pathways, which provides basis for its clinical application and promising directions for subsequent research.
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Affiliation(s)
- Yonggan Ying
- Department of Pain, Li Huili Hospital Affiliated to Ningbo University, Ningbo, China
| | - Zhaopeng Tang
- Department of Orthopaedics, Gansu Provincial Hospital of TCM, Lanzhou, China
| | - Feng Niu
- Department of Orthopaedics & Traumatology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Ningbo, China
| | - Taotao Xu
- Department of Orthopaedics & Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chenjie Xia
- Department of Orthopaedics, Li Huili Hospital Affiliated to Ningbo University, Ningbo, China
| | - Shuijun Zhang
- Department of Orthopedics, Zhejiang Provincial People’s Hospital, Hangzhou, China
- *Correspondence: Shuijun Zhang, Department of Orthopedic Surgery, Zhejiang Provincial People’s Hospital, No. 158, Shangtang Road, Hangzhou, Zhejiang Province 310014, China (e-mail: )
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18
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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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19
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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: 2] [Impact Index Per Article: 1.0] [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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20
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Morse KW, Heinz NK, Abolade JM, Wright-Chisem J, Alice Russell L, Zhang M, Mirza S, Pearce-Fisher D, Orange DE, Figgie MP, Sculco PK, Goodman SM. Factors Associated With Increasing Length of Stay for Rheumatoid Arthritis Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty. HSS J 2022; 18:196-204. [PMID: 35645648 PMCID: PMC9096994 DOI: 10.1177/15563316221076603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022]
Abstract
Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are cost-effective procedures that decrease pain and improve health-related quality of life for patients with advanced symptomatic arthritis, including rheumatoid arthritis (RA). Patients with RA have a longer length of stay (LOS) after THA or TKA than patients with osteoarthritis, yet the factors contributing to LOS have not been investigated. Purpose: We sought to identify the factors contributing to LOS for patients with RA undergoing THA and TKA at a single tertiary care orthopedic specialty hospital. Methods: We retrospectively reviewed data from a prospectively collected cohort of 252 RA patients undergoing either THA or TKA. Demographics, RA characteristics, medications, serologies, and disease activity were collected preoperatively. Linear regression was performed to explore the relationship between LOS (log-transformed) and possible predictors. A multivariate model was constructed through backward selection using significant predictors from a univariate analysis. Results: Of the 252 patients with RA, 83% were women; they had a median disease duration of 14 years and moderate disease activity at the time of arthroplasty. We had LOS data on 240 (95%) of the cases. The mean LOS was 3.4 ± 1.5 days. The multivariate analysis revealed a longer LOS for RA patients who underwent TKA versus THA, were women versus men, required a blood transfusion, and took preoperative opioids. Conclusion: Our retrospective study found that increased postoperative LOS in RA patients undergoing THA or TKA was associated with factors both non-modifiable (type of surgery, sex) and modifiable (postoperative blood transfusion, preoperative opioid use). These findings suggest that preoperative optimization of the patient with RA might focus on improving anemia and reducing opioid use in efforts to shorten LOS. More rigorous study is warranted.
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Affiliation(s)
- Kyle W. Morse
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Kyle W. Morse, MD, Department of Medicine,
Hospital for Special Surgery, 535 E 70th St., New York, NY 10021, USA.
| | - Nicole K. Heinz
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA
| | - Jeremy M. Abolade
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA
| | | | - Linda Alice Russell
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Department of Medicine, Weill Cornell
Medicine, New York, NY, USA
| | - Meng Zhang
- Department of Medicine, Feinstein
Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Serene Mirza
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA
| | | | - Dana E. Orange
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Rockefeller University, New York, NY,
USA
| | - Mark P. Figgie
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Department of Medicine, Weill Cornell
Medicine, New York, NY, USA
| | - Peter K. Sculco
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Department of Medicine, Weill Cornell
Medicine, New York, NY, USA
| | - Susan M. Goodman
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Department of Medicine, Weill Cornell
Medicine, New York, NY, USA
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21
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Taylor-Williams O, Inderjeeth CA, Almutairi KB, Keen H, Preen DB, Nossent JC. Total Hip Replacement in Patients with Rheumatoid Arthritis: Trends in Incidence and Complication Rates Over 35 Years. Rheumatol Ther 2022; 9:565-580. [PMID: 34997912 PMCID: PMC8964887 DOI: 10.1007/s40744-021-00414-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/09/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Advances in rheumatoid arthritis (RA) management have made disease remission achievable. We evaluated trends in total hip replacement (THR) and postoperative outcomes in patients with RA in Western Australia (WA) over more than three decades. METHODS This was a retrospective analysis of routinely collected prospective data from a state-wide registry containing longitudinally linked administrative health data based on International Classification of Diseases (ICD) diagnostic and procedural codes. We included patients with two or more diagnostic codes for RA (between 1980 and 2015) and studied THR incidence rates (THR IR) and complication rates (revision, peri-prosthetic fracture, infection, venous thrombosis, and mechanical loosening). Survival rates were estimated by Kaplan-Meier method and predictors analyzed by Cox regression. RESULTS We followed 9201 RA patients over 111,625 person-years, during which 1560 patients (16.9%) underwent THR. From 1985 to 2015, THR IR (per 1000 RA patient-years) decreased from 20.8 (95% CI 20.1-21.5) to 7.3 (95% CI 7.2-7.5), and 5-year THR-free survival increased from 84.3 to 95.3% (1980-2015). Ten-year prosthetic survival was 91.2%. Complication rates in the first 5 years post-THR decreased significantly from 13.1 to 3.7% (p < 0.001). Mechanical complications such as loosening and periprosthetic fracture rates decreased significantly (> 35%, P < 0.05), while infection and revision did not change over the observation period (p > 0.05). CONCLUSIONS Over the last 30 years in RA patients, THR IR and mechanical complication rates decreased significantly, but the medical complication of infection has not changed significantly.
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Affiliation(s)
- Owen Taylor-Williams
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
| | - Charles A Inderjeeth
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Khalid B Almutairi
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
| | - Helen Keen
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Department of Rheumatology, Fiona Stanley Hospital, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Johannes C Nossent
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia.
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
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22
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Hu S, Xue Y, He J, Chen C, Sun J, Jin Y, Zhang Y, Shi Q, Rui Y. Irisin recouples osteogenesis and osteoclastogenesis to protect wear-particle-induced osteolysis by suppressing oxidative stress and RANKL production. Biomater Sci 2021; 9:5791-5801. [PMID: 34323888 DOI: 10.1039/d1bm00563d] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The disruption of bone homeostasis with the decrease in osteoblastic bone formation and facilitated osteoclastic bone resorption is the leading cause of periprosthetic osteolysis. Accumulative studies have indicated that irisin has the function of maintaining and rebalancing bone homeostasis. In this study, we explored the protective effect of irisin on wear-particle-induced osteolysis in mice. The results showed that irisin effectively inhibited titanium (Ti) particle-induced calvarial osteolysis, supported by a lower bone loss and existence of more collagen, compared with the ones stressed by Ti particles. Further analysis demonstrated that irisin not only rescued Ti-particle-impaired osteogenesis derived from bone mesenchymal stem cells (BMSCs) but also alleviated the increase in wear-particle-induced nuclear factor-κB ligand (RANKL) secreted by BMSCs-derived osteoblasts, which consequently restrained the activation of osteoclasts. Meanwhile, irisin inhibited osteoclastogenesis by the direct inactivation of reactive oxygen species (ROS) signaling. These results revealed that irisin functions to fight against osteolysis caused by wear particles through rebalancing the periprosthetic bone homeostasis microenvironment, which may provide a potential therapeutic strategy for the management of osteolysis and induced prosthetic loosening.
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Affiliation(s)
- Sihan Hu
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Orthopedics Institute of Soochow University, Medical College of Soochow University, Suzhou, Jiangsu 215006, P. R. China.
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23
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Ohashi H, Nishida K, Nasu Y, Saiga K, Nakahara R, Horita M, Okita S, Ozaki T. A Novel Radiographic Measurement Method for the Evaluation of Metatarsophalangeal Joint Dislocation of the Lesser Toe in Patients with Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147520. [PMID: 34299970 PMCID: PMC8303857 DOI: 10.3390/ijerph18147520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022]
Abstract
Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (−0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.
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Affiliation(s)
- Hideki Ohashi
- Department of Orthopaedic Surgery, Takahashi Central Hospital, Okayama 716-0033, Japan;
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.H.); (T.O.)
- Correspondence: ; Tel.: +81-86-235-7273
| | - Yoshihisa Nasu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (Y.N.); (K.S.); (R.N.)
| | - Kenta Saiga
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (Y.N.); (K.S.); (R.N.)
| | - Ryuichi Nakahara
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (Y.N.); (K.S.); (R.N.)
| | - Masahiro Horita
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.H.); (T.O.)
| | - Shunji Okita
- Department of Orthopaedic Surgery, Okayama City Hospital, Okayama 700-0962, Japan;
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.H.); (T.O.)
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24
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Tung KK, Lee YH, Lin CC, Lee CH, Lin MC, Wei JCC. Opposing Trends in Total Knee and Hip Arthroplasties for Patients With Rheumatoid Arthritis vs. the General Population-A 14-Year Retrospective Study in Taiwan. Front Med (Lausanne) 2021; 8:640275. [PMID: 33959623 PMCID: PMC8095393 DOI: 10.3389/fmed.2021.640275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine the trend of incidence rate of total knee arthroplasty (TKA), total hip arthroplasty (THA), and TKA or THA (major joint arthroplasty, MJA) among rheumatoid arthritis (RA) population and compared them with general population (GP) in Taiwan. Methods: Incidence rates and trends of TKA, THA, and MJA were determined over a 14-year period (2000–2013) among RA patients and compared them with GP. RA of patients was diagnosed based on the ACR 1987 criteria and extracted from GP. Subanalyses of incidences of TKA, THA, and MJA by year, 10-year age group, and gender were further conducted for demographic analysis. Patient profiles were extracted from the National Health Insurance Research Database (NHIRD) for interrupted time-series analysis and cohort studies. Results: Patients enrolled were 168,457 receiving TKA, 64,543 receiving THA, and 228,191 receiving MJA surgery. Incidences of TKA, THA, and MJA in RA patients were significantly lower by 49.0, 41.5, and 41.0% compared with concomitantly rises in GP by 131.0, 25.1, and 90.0% among the GP during the study period. The dominant age population for TKA, THA, and MJA were those aged 70–79 years in both GP and RA groups. Conclusions: We found an opposing trend in incidence of TKA, THA, and MJA between RA patients and the GP. The possible influence of pharmacological treatment is implicated for the lower incidence rates of TKA, THA, and MJA surgeries among RA patients.
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Affiliation(s)
- Kuan-Kai Tung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yung-Heng Lee
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan.,Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan.,Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Chuan-Chao Lin
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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25
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Nettrour JF, Bailey BS, Burch MB, Clair DD, June RR, Olsen NJ, Ba DM, Liu G, Leslie DL. Arthroplasty Rates Not Increasing in Young Patients With Rheumatoid Arthritis: A National Database Review, 2005 Versus 2014. Arthroplast Today 2021; 8:118-123. [PMID: 33748370 PMCID: PMC7970009 DOI: 10.1016/j.artd.2021.02.002] [Citation(s) in RCA: 1] [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: 09/25/2020] [Revised: 01/15/2021] [Accepted: 02/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background For 20 years, authors have predicted an expansion in total knee arthroplasty (TKA) and total hip arthroplasty (THA) utilization. Over this same period, the introduction of biological disease-modifying antirheumatic drugs has dramatically altered the treatment of rheumatoid arthritis (RA) with hopes of preventing articular damage and obviating the need for prosthetic replacement. The goal of our investigation was to evaluate TKA and THA utilization in young patients with RA (<65 years) in 2005 vs 2014 compared to patients with osteoarthritis (OA). Methods Using relevant International Classification of Disease Ninth Revision (ICD-9) and Current Procedural Terminology codes, the Truven MarketScan Database (over 46 million enrollees) was queried to determine THA and TKA incidence rates for RA and OA patients aged <65 years during the final decade of ICD-9 use. Patients with potentially confounding ICD-9 codes were excluded to limit coding variation. Statistical analysis consisted of student t-tests, Pearson's chi-square tests, and Breslow-Day tests. Results For patients with OA, TKAs increased substantially from 0.07% in 2005 to 0.1% in 2014 (+42.9% change, P < .001). Similarly for patients with OA, THAs increased from 0.04% to 0.06% over the same time period (+66.0% change, P < .001). For young patients with RA, the rate of TKA remained relatively stable—1.06% in 2005 to 1.04% in 2014 (−1.7% change, P = .65)—as did THA—0.44% to 0.48% (+9.0% change, P = .14). Conclusions Dramatic increases in THA and TKA rates for OA patients aged <65 years were indeed observed from 2005 to 2014. This trend, however, was not seen in the RA population where TKA and THA rates remained unchanged.
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Affiliation(s)
- John F Nettrour
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Bradley S Bailey
- Division of Rheumatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Major B Burch
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Devin D Clair
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Rayford R June
- Division of Rheumatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA.,Lebanon Veteran's Administration Medical Center, Lebanon, PA, USA
| | - Nancy J Olsen
- Division of Rheumatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Djibril M Ba
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.,Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.,Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.,Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA, USA
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26
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Lee YH, Ko PY, Kao SL, Lin MC, Cheng-Chung Wei J. Risk of Total Knee and Hip Arthroplasty in Patients With Rheumatoid Arthritis: A 12-Year Retrospective Cohort Study of 65,898 Patients. J Arthroplasty 2020; 35:3517-3523. [PMID: 32778419 DOI: 10.1016/j.arth.2020.06.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an inflammatory disease that causes the destruction of soft tissues and cartilage around joints. Owing to the widespread use of potent disease-modifying antirheumatic drugs, the need for total knee and hip arthroplasties (TKA and THA) has been reduced in patients with RA. However, the current association between RA and either THA or TKA has not been demonstrated in large-scale epidemiological studies. METHODS We conducted a large-scale retrospective cohort study of patients diagnosed with RA during a 12-year period (2000-2012) in Taiwan. We recruited 32,949 patients with RA and 32,949 individually propensity score-matched non-RA controls. RESULTS After adjusting for confounding factors, we found that the risk of THA or TKA was 4.02 times higher in patients with RA than in those without RA (95% confidence interval [CI], 3.77-4.52). The risk of THA or TKA was highest in patients with RA younger than 40 years (adjusted hazard ratio, 43.18; 95% CI, 16.01-116.47). Compared with non-RA patients, patients with RA were 4.82 times more likely to undergo THA (95% CI, 3.84-6.04), 3.85 times more likely to undergo TKA (95% CI, 3.48-4.25), and 19.06 times more likely to undergo both THA and TKA (95% CI, 8.90-40.80). CONCLUSION These findings document a 4.02-fold greater long-term risk of undergoing THA or TKA in RA patients relative to non-RA patients in Taiwan.
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Affiliation(s)
- Yung-Heng Lee
- Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan; Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan; Department of Center for General Education, National United University, Miaoli, Taiwan
| | - Po-Yun Ko
- Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Su-Ling Kao
- Department of Human Resource, Chia Yi Hospital, Ministry of Health and Welfare, Chia Yi, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Rheumatology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China; Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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27
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Ward MM. Accuracy of diagnoses of inflammatory arthritis in administrative hospitalization databases. Pharmacoepidemiol Drug Saf 2020; 30:257-265. [PMID: 33089918 DOI: 10.1002/pds.5157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE Studies using administrative hospitalization data often classify patients as having inflammatory arthritis based on diagnoses recorded at the hospitalization. We examined the agreement of these diagnoses with patients' prior medical histories. METHODS We identified Medicare beneficiaries hospitalized in 2011 to 2015 for total hip arthroplasty (THA), total knee arthroplasty (TKA), acute myocardial infarction (AMI), or sepsis. We compared diagnoses of rheumatoid arthritis (RA) or ankylosing spondylitis (AS) at the index hospitalization to diagnoses over prior inpatient and outpatient claims. To assess the impact of potential misclassification, we compared hospital outcomes using the alternative methods of detecting beneficiaries with arthritis. Analyses were repeated using Medicaid data. RESULTS Among 506 781 Medicare beneficiaries with THA, 18282 had RA and 571 had AS at the arthroplasty hospitalization, while 13 212 had RA and 1519 had AS based on claims history. Diagnoses at the hospitalization were highly specific (0.98-0.99), but sensitivities (0.65 for RA; 0.31 for AS) and positive predictive values (PPV) (0.47 for RA; 0.83 for AS) were lower. For TKA, AMI, and sepsis, specificities were 0.97 to 0.99, sensitivities 0.60 to 0.66 for RA and 0.18 to 0.22 for AS, and PPVs 0.43 to 0.47 for RA and 0.73 to 0.77 for AS. In Medicaid, sensitivities were 0.21 to 0.67 for RA and 0.07 to 0.49 for AS. Frequencies of some hospital outcomes differed when arthritis was classified by the index hospitalization or claims history. CONCLUSION Diagnoses of RA and AS in hospitalization databases are highly specific but fail to identify large proportions of patients with these diagnoses.
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Affiliation(s)
- Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
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28
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Iyer P, Gao Y, Field EH, Curtis JR, Lynch CF, Vaughan-Sarrazin M, Singh N. Trends in Hospitalization Rates, Major Causes of Hospitalization, and In-Hospital Mortality in Rheumatoid Arthritis in the United States From 2000 to 2014. ACR Open Rheumatol 2020; 2:715-724. [PMID: 33215872 PMCID: PMC7738807 DOI: 10.1002/acr2.11200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate national trends in hospitalizations and in‐hospital mortality in rheumatoid arthritis (RA). Methods National Inpatient Sample from 2000‐2014 and United States Census data were used to study temporal trends in adult RA hospitalizations, reasons for hospitalizations, and in‐hospital mortality. Results The data represented 183 983 hospitalizations with a primary diagnosis of RA. The annual rates of hospitalization for the primary diagnosis of RA decreased from 76.54 admissions per 1 million in 2000 to 29.96 per 1 million in 2014 (P trend < 0.0001). The hospital mortality rate declined from 0.70% to 0.41% (P trend < 0.0001) in this group. With a primary or nonprimary diagnosis of RA, the mortality rate ranged between 1.95 and 2.87 (P trend 0.08). For a nonprimary diagnosis of RA, we noted that the proportion of hospitalizations with a diagnosis of myocardial infarction (6.4% in 2000 to 4.6% in 2014; P < 0.001) significantly decreased, but the absolute number of hospitalizations significantly increased. In contrast, the proportion and the absolute number of hospitalizations with any diagnosis of sepsis, congestive heart failure, lung disease, and urinary tract infection increased significantly. We also noted a significant increase in the actual rate and proportions for hospitalizations for hip and knee arthroplasty. Among in‐hospital deaths when RA was a nonprimary diagnosis, the most common primary diagnosis was pneumonia (12.5 %) in 2000, whereas sepsis accounted for the most deaths in 2014 (31.4%). Conclusion We observed that hospitalization rates and in‐hospital mortality rates in patients with RA have changed significantly over the past 15 years.
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Affiliation(s)
| | - Yubo Gao
- Iowa City Veteran's Affairs Medical Center, and University of Iowa, Iowa City, Iowa
| | - Elizabeth H Field
- Iowa City Veteran's Affairs Medical Center, and University of Iowa, Iowa City, Iowa.,University of Iowa, Iowa City
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29
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Taylor-Williams O, Nossent J, Inderjeeth CA. Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades. Rheumatol Ther 2020; 7:685-702. [PMID: 33000421 PMCID: PMC7695804 DOI: 10.1007/s40744-020-00238-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/19/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Over the past several decades, management of rheumatoid arthritis (RA) has evolved significantly, but few studies have examined the real-world impact of these changes on orthopaedic surgery in patients with RA. This systematic review assessed total hip arthroplasty (THA) incidence and postoperative complication rates across the past four decades. METHODS This is a systematic literature review sourcing data on THA in patients with RA from the electronic databases MEDLINE, EMBASE, Scopus, and Cochrane between January 1, 1980 and December 31, 2019. RESULTS The search retrieved 1715 articles of which 44 were included for quantitative synthesis. The rate for THA decreased by almost 40% from 11/1000 patient years (PY) in the 2000s to 7/1000 PY in the 2010s, while the overall complication rate decreased from 9.9% in the 1990s to 5.3% in the 2010s. Throughout the duration of the study, THA incidence and overall complication rate decreased. However, not all individual complication rates decreased. For example, revision and periprosthetic fracture decreased, infection and aseptic loosening remained constant, and dislocation increased. CONCLUSION Medical management of patients with RA has reduced the need for THA, while postoperative medical and surgical management has improved some postoperative outcomes. Nevertheless, there remains room for further improvement to postoperative outcomes through RA-specific management.
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Affiliation(s)
| | - Johannes Nossent
- School of Medicine, The University of Western Australia, Perth, Australia.
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia.
| | - Charles A Inderjeeth
- School of Medicine, The University of Western Australia, Perth, Australia.
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia.
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30
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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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31
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Wang JH, Ma HH, Chou TFA, Tsai SW, Chen CF, Wu PK, Chen WM. Outcomes following total elbow arthroplasty for rheumatoid arthritis versus post-traumatic conditions: a systematic review and meta-analysis. Bone Joint J 2019; 101-B:1489-1497. [PMID: 31786989 PMCID: PMC6896228 DOI: 10.1302/0301-620x.101b12.bjj-2019-0799.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS The aim of this meta-analysis was to compare the outcome of total elbow arthroplasty (TEA) undertaken for rheumatoid arthritis (RA) with TEA performed for post-traumatic conditions with regard to implant failure, functional outcome, and perioperative complications. MATERIALS AND METHODS We completed a comprehensive literature search on PubMed, Web of Science, Embase, and the Cochrane Library and conducted a systematic review and meta-analysis. Nine cohort studies investigated the outcome of TEA between RA and post-traumatic conditions. The preferred reporting items for systematic reviews and meta-analysis (Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) guidelines and Newcastle-Ottawa scale were applied to assess the quality of the included studies. We assessed three major outcome domains: implant failures (including aseptic loosening, septic loosening, bushing wear, axle failure, component disassembly, or component fracture); functional outcomes (including arc of range of movement, Mayo Elbow Performance Score (MEPS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), and perioperative complications (including deep infection, intraoperative fracture, postoperative fracture, and ulnar neuropathy). RESULTS This study included a total of 679 TEAs for RA (n = 482) or post-traumatic conditions (n = 197). After exclusion, all of the TEAs included in this meta-analysis were cemented with linked components. Our analysis demonstrated that the RA group was associated with a higher risk of septic loosening after TEA (odds ratio (OR) 3.96, 95% confidence interval (CI) 1.11 to 14.12), while there was an increased risk of bushing wear, axle failure, component disassembly, or component fracture in the post-traumatic group (OR 4.72, 95% CI 2.37 to 9.35). A higher MEPS (standardized mean difference 0.634, 95% CI 0.379 to 0.890) was found in the RA group. There were no significant differences in arc of range of movement, DASH questionnaire, and risk of aseptic loosening, deep infection, perioperative fracture, or ulnar neuropathy. CONCLUSION The aetiology of TEA surgery appears to have an impact on the outcome in terms of specific modes of implant failures. RA patients might have a better functional outcome after TEA surgery. Cite this article: Bone Joint J 2019;101-B:1489-1497.
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Affiliation(s)
- Jou-Hua Wang
- Department of Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Te-Feng A Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Mulholland BS, Forwood MR, Morrison NA. Monocyte Chemoattractant Protein-1 (MCP-1/CCL2) Drives Activation of Bone Remodelling and Skeletal Metastasis. Curr Osteoporos Rep 2019; 17:538-547. [PMID: 31713180 PMCID: PMC6944672 DOI: 10.1007/s11914-019-00545-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to explore the role of monocyte chemoattractant protein-1 (MCP-1 or CCL2) in the processes that underpin bone remodelling, particularly the action of osteoblasts and osteoclasts, and its role in the development and metastasis of cancers that target the bone. RECENT FINDINGS MCP-1 is a key mediator of osteoclastogenesis, being the highest induced gene during intermittent treatment with parathyroid hormone (iPTH), but also regulates catabolic effects of continuous PTH on bone including monocyte and macrophage recruitment, osteoclast formation and bone resorption. In concert with PTH-related protein (PTHrP), MCP-1 mediates the interaction between tumour-derived factors and host-derived chemokines to promote skeletal metastasis. In breast and prostate cancers, an osteolytic cascade is driven by tumour cell-derived PTHrP that upregulates MCP-1 in osteoblastic cells. This relationship between PTHrP and osteoblastic expression of MCP-1 may drive the colonisation of disseminated breast cancer cells in the bone. There is mounting evidence to suggest a pivotal role of MCP-1 in many diseases and an important role in the establishment of comorbidities. Coupled with its role in bone remodelling and the regulation of bone turnover, there is the potential for pathological relationships between bone disorders and bone-related cancers driven by MCP-1. MCP-1's role in bone remodelling and bone-related cancers highlights its potential as a novel anti-resorptive and anti-metastatic target.
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Affiliation(s)
- Bridie S Mulholland
- School of Medical Science and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, 4222, Australia
| | - Mark R Forwood
- School of Medical Science and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, 4222, Australia
| | - Nigel A Morrison
- School of Medical Science and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, 4222, Australia.
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Hawley S, Edwards CJ, Arden NK, Delmestri A, Cooper C, Judge A, Prieto-Alhambra D. Descriptive epidemiology of hip and knee replacement in rheumatoid arthritis: An analysis of UK electronic medical records. Semin Arthritis Rheum 2019; 50:237-244. [PMID: 31492436 DOI: 10.1016/j.semarthrit.2019.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/08/2019] [Accepted: 08/22/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To provide descriptive data on rates of total hip replacement (THR) and total knee replacement (TKR) within a large RA cohort and describe variation in risk. METHODS Incident RA patients (1995 to 2014) were identified from the Clinical Practice Research Datalink (CPRD). First subsequent occurrence of THR and TKR were identified (analysed separately) and incidence rates calculated, stratified by sex, age, BMI, geographic region, and quintiles of the index of multiple deprivation (IMD) score. RESULTS There were 27,607 RA patients included, with a total of 1,028 THRs (mean age at surgery: 68.4 years) and 1,366 TKRs (mean age at surgery: 67.6 years), at an overall incidence rate per 1,000 person-years (PYs) [95% CI] of 6.38 [6.00-6.78] and 8.57 [8.12-9.04], respectively. TKR incidence was similar by gender but THR rates were higher in females than males. Rates of TKR but not THR rose according to BMI. An increasing trend was observed in rates of both outcomes according to age (although not ≥75) but of decreasing rates according to socio-economic deprivation. There was some evidence for regional variation in TKR. The 10-year cumulative incidence was 5.2% [4.9, 5.6] and 7.0% [6.6, 7.4] for THR and TKR, respectively. CONCLUSION We provide generalizable estimates of THR and TKR incidence in the UK RA patient population and note variation across several key variables. Increased BMI was associated with a large increase in TKR but not THR incidence. Increased deprivation was associated with a downward trend in rates of THR and TKR.
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Affiliation(s)
- Samuel Hawley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - Christopher J Edwards
- NIHR Clinical Research Facility, University Hospital Southampton, Southampton, United Kingdom
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Unviersitat Autonoma de Barcelona and Insituto de Salud Carlos III, Barcelona, Spain
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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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Wylezinski LS, Gray JD, Polk JB, Harmata AJ, Spurlock CF. Illuminating an Invisible Epidemic: A Systemic Review of the Clinical and Economic Benefits of Early Diagnosis and Treatment in Inflammatory Disease and Related Syndromes. J Clin Med 2019; 8:E493. [PMID: 30979036 PMCID: PMC6518102 DOI: 10.3390/jcm8040493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
Healthcare expenditures in the United States are growing at an alarming level with the Centers for Medicare and Medicaid Services (CMS) projecting that they will reach $5.7 trillion per year by 2026. Inflammatory diseases and related syndromes are growing in prevalence among Western societies. This growing population that affects close to 60 million people in the U.S. places a significant burden on the healthcare system. Characterized by relatively slow development, these diseases and syndromes prove challenging to diagnose, leading to delayed treatment against the backdrop of inevitable disability progression. Patients require healthcare attention but are initially hidden from clinician's view by the seemingly generalized, non-specific symptoms. It is imperative to identify and manage these underlying conditions to slow disease progression and reduce the likelihood that costly comorbidities will develop. Enhanced diagnostic criteria coupled with additional technological innovation to identify inflammatory conditions earlier is necessary and in the best interest of all healthcare stakeholders. The current total cost to the U.S. healthcare system is at least $90B dollars annually. Through unique analysis of financial cost drivers, this review identifies opportunities to improve clinical outcomes and help control these disease-related costs by 20% or more.
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Affiliation(s)
- Lukasz S Wylezinski
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- IQuity, Inc., Nashville, TN 37203, USA.
| | | | | | | | - Charles F Spurlock
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- IQuity, Inc., Nashville, TN 37203, USA.
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Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, Carr A, Beard D. Knee replacement. Lancet 2018; 392:1672-1682. [PMID: 30496082 DOI: 10.1016/s0140-6736(18)32344-4] [Citation(s) in RCA: 401] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022]
Abstract
Knee replacement surgery is one of the most commonly done and cost-effective musculoskeletal surgical procedures. The numbers of cases done continue to grow worldwide, with substantial variation in utilisation rates across regions and countries. The main indication for surgery remains painful knee osteoarthritis with reduced function and quality of life. The threshold for intervention is not well defined, and is influenced by many factors including patient and surgeon preference. Most patients have a very good clinical outcome after knee replacement, but multiple studies have reported that 20% or more of patients do not. So despite excellent long-term survivorship, more work is required to enhance this procedure and development is rightly focused on increasing the proportion of patients who have successful pain relief after surgery. Changing implant design has historically been a target for improving outcome, but there is greater recognition that improvements can be achieved by better implantation methods, avoiding complications, and improving perioperative care for patients, such as enhanced recovery programmes. New technologies are likely to advance future knee replacement care further, but their introduction must be regulated and monitored with greater rigour to ensure patient safety.
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Affiliation(s)
- Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK.
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Jeffrey N Katz
- Department of Orthopedic Surgery and Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gary Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
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Premkumar A, Morse K, Levack AE, Bostrom MP, Carli AV. Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: Prevention and Diagnosis. Curr Rheumatol Rep 2018; 20:68. [PMID: 30203376 DOI: 10.1007/s11926-018-0777-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Periprosthetic joint infection (PJI) is a devastating complication that can occur following total joint arthroplasty (TJA), causing significant morbidity and often requiring revision surgery. This goal of this manuscript is to review the current evidence for the prevention and diagnosis of PJI in patients with inflammatory arthritis. RECENT FINDINGS Patients with inflammatory arthritis have a higher risk of PJI after TJA; however, there are several preventive, diagnostic, and therapeutic measures that can be optimized to lower the burden of PJI in this population. This manuscript will review the current evidence and clinical practice recommendations that support specific features of preoperative evaluation, perioperative medication management, and surgical planning in inflammatory arthritis patients undergoing TJA. Evidence and recommendations for the diagnosis of PJI in this patient population will also be reviewed. Despite increased research efforts directed towards PJI, specific approaches directed at the inflammatory arthritis patient population remain surprisingly limited. Optimization strategies such as adequately managing disease-modifying medications, treating preoperative anemia, encouraging smoking cessation, and improving weight management are strongly encouraged before entering the perioperative period. If PJI does occur in the inflammatory arthritis patient, establishing the diagnosis is challenging, since guidelines were created from investigations of PJI in primarily patients without inflammatory arthritis. Future prospective research is required to better guide clinicians in preventing and diagnosing PJI in inflammatory arthritis patients undergoing TJA.
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Affiliation(s)
- Ajay Premkumar
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Kyle Morse
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ashley E Levack
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Mathias P Bostrom
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alberto V Carli
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Holinka J. [Change in rheumatic hip surgery]. Z Rheumatol 2018; 77:896-898. [PMID: 30191388 DOI: 10.1007/s00393-018-0529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
There is a trend towards a reduction in joint-preserving hip surgery, such as synovectomy and total hip joint replacement in rheumatic patients. This is mostly due to the success of biological disease-modifying antirheumatic drugs (bDMARD) in systemic anti-rheumatic therapy. The results of hip surgery in rheumatic patients are comparable to those in non-rheumatic patients, except for prosthetic joint infections, which are higher in patients with rheumatoid arthritis. Especially in hip surgery there was a big evolution in the last few years including a broad range of minimally invasive surgical methods, such as hip arthroscopy, mini-open hip surgery and minimally invasive hip arthroplasty with bone preservation or short femoral shafts. These surgical methods also have an advantage in the treatment of typical rheumatoid pathologies and have the benefit of a rapid recovery.
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Affiliation(s)
- J Holinka
- Universitätsklinik für Orthopädie und Unfallchirurgie, Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Harjula JNE, Paloneva J, Haapakoski J, Kukkonen J, Äärimaa V. Increasing incidence of primary shoulder arthroplasty in Finland - a nationwide registry study. BMC Musculoskelet Disord 2018; 19:245. [PMID: 30031390 PMCID: PMC6054850 DOI: 10.1186/s12891-018-2150-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of shoulder arthroplasties is reportedly increasing and the types of arthroplasty are changing. The purpose of this study was to investigate the incidence of primary shoulder arthroplasty in Finland. Methods We analyzed nationwide data from the Finnish Arthroplasty Register (FAR) and the Finnish National Hospital Discharge Register (NHDR) during time period 2004–2015. The primary outcome variable was the incidence of shoulder arthroplasty per 100,000 person-years stratified by age, sex and year of surgery. The secondary outcome variables were surgical indication, arthroplasty type and prosthesis model. Results The number of primary shoulder arthroplasties was 7504 (women = 4878, men = 2625). The rate of operations increased from 6 to 15 per 100,000 person-years among men, and 11 to 26 per 100,000 person-years among women. The indication for arthroplasty was osteoarthritis in 56%, acute fracture in 21%, inflammatory arthritis in 13%, and rotator cuff arthropathy in 4% of the cases. Hemiarthroplasties accounted for 66%, total shoulder arthroplasties 8%, and reverse shoulder arthroplasties 12% of the cases, 14% of the cases was missing. During the 12-year study period the incidence of hemiarthroplasties decreased by 23% and the number of total shoulder and reverse shoulder arthroplasty increased by 500 and 4500%, respectively. Conclusions The incidence of primary shoulder arthroplasty has increased by 160% during the study period in Finland. The incidence of hemiarthroplasties decreased while total and reverse shoulder arthroplasties increased. Electronic supplementary material The online version of this article (10.1186/s12891-018-2150-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenni N E Harjula
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland.
| | - Juha Paloneva
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland
| | | | - Juha Kukkonen
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Satakunta Central Hospital and University of Turku, Turku, Finland
| | - Ville Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
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Goodman SM. Do Recent Trends in RA Surgery Reflect Success in Disease Management? J Rheumatol 2018; 45:147-149. [PMID: 29419445 DOI: 10.3899/jrheum.171056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Susan M Goodman
- Attending Rheumatologist, Division of Rheumatology, Hospital for Special Surgery, Professor of Clinical Medicine, Department of Medicine, Weill Cornell Medical School, New York, New York, USA.
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