Changes in the rates of joint surgery among patients with rheumatoid arthritis in California, 1983-2007

Abstract

Objectives Treatment of patients with rheumatoid arthritis (RA) has improved markedly over the past 25 years. We investigated if rates of joint surgery, a long-term consequence of poorly-controlled RA, have changed over this period. Methods In this population-based, serial cross-sectional study of patients aged ≥ 40 years with RA in California, we examined trends in annual rates of total knee arthroplasty, total hip arthroplasty, total ankle arthroplasty or arthrodesis, and total wrist arthroplasty or arthrodesis from 1983–2007. Results Rates of joint surgery peaked in the 1990s and since have decreased. Among patients aged 40–59 years, rates of knee surgery in 2003–2007 were 19% lower than in 1983–1987 (adjusted rate ratio 0.81; 95% confidence interval (CI) 0.74 – 0.87, P < 0.0001), while rates of hip surgery in 2003–2007 were 40% lower (P < 0.0001). Rates of knee and hip surgery did not decrease in patients aged ≥ 60 years but increased as observed in the general population. Compared with rates of ankle and wrist surgery in the mid-1980s, rates in the mid-2000s decreased significantly in both age groups. Conclusions Rates of joint surgery in RA peaked in the 1990s and have declined thereafter, suggesting that long-term outcomes of RA are improving.

Effects of Concomitant Methotrexate on Large Joint Replacement in Patients With Rheumatoid Arthritis Treated With Tumor Necrosis Factor Inhibitors: A Multicenter Retrospective Cohort Study in Japan

“…In a sense, total joint replacement represents the failure of medical treatment to control RA adequately, and the incidence of total joint replacement is a measure of disease progression and the ineffectiveness of treatment (14). The incidence of total joint replacement decreases with time, likely due to advances in RA treatment with MTX and biologic DMARDs (23)(24)(25)(26)(27). A previous study suggested that in order to inhibit the need for total joint replacement in patients treated with TNF inhibitors, it is important to maintain tight control over RA activity (28).…”

Rheumatoid Hand Surgery: Is there a Decline? A 22-Year Population-Based Study

“…Previous studies have shown a reduction in the rates of orthopaedic joint arthroplasty for rheumatoid patients [8,11,12,18,23] as well as a recent study that highlights the apparent decline of hand surgery for patients with RA [5].…”

Knee Pain in Adults & Adolescents, Diagnosis and Treatment

“…In a study of Californian adults over two decades Louie et al 2010 [13] noted that the demand for knee arthroplasty decreased in younger patients, and paralleled the general population requirements in older patients. The introduction of the use of methotrexate in the 1970s, and more recently the use of Tumour Necrosis Factor α has been attributed to milder forms of the disease and the slowing of radiographic deterioration [14].…”

“…Without appropriate pharmacological treatment or surgical intervention it can lead to profound disability and pain. The evolution of disease modifying anti-rheumatoid drugs (DMARDs) has had a significant effect on the number of patients requiring surgery [13].…”