Trends in Treatment, Outcomes, and Incidence of Orthopedic Surgery in Patients with Rheumatoid Arthritis: An Observational Cohort Study Using the Japanese National Database of Rheumatic Diseases

Matsumoto, Takumi; Nishino, Jinju; Izawa, Naohiro; Naito, Masashi; Hirose, Jun; Tanaka, Sakae; Yasui, Testuro; Saisho, Koichiro; Tohma, Shigeto

doi:10.3899/jrheum.170046

Cited by 41 publications

(25 citation statements)

References 36 publications

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“…Our results were in conformity with other international studies that showed the reduction in surgical treatment indications. [11][12][13] In a Norwegian population, 13 a study conducted in 6394 RA patients between 1994 and 2012 showed that the incidence of arthroplasties decreased from 7.5 p/100,000 person-year in 1997 to 0.5/100,000 person-year in 2012. Concerning synovectomy and arthrodesis, their rate decreased from 5.4 and 10.3/100,000 person-year in 1997 to 1.1 and 5.7/100,000 person-year in 2012, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Concerning synovectomy and arthrodesis, their rate decreased from 5.4 and 10.3/100,000 person-year in 1997 to 1.1 and 5.7/100,000 person-year in 2012, respectively. Moreover, in Japanese patients with RA, 12 total number of surgical treatment decreased from 72/1,000 in 2004 to 51.5/1,000 in 2014 with a reduction from 11.5/1,000 to 6.1/1,000 for total hip replacement and from 30.1/1,000 to 8.51/1,000 for total knee replacement.…”

Section: Discussionmentioning

confidence: 99%

“…14 We have found that surgical treatment was associated with young age of disease onset (OR: 2.79 95% CI: 1.49-5.22), in concordance with a Japanese study. 12 Feldman et al 17 have shown that surgical treatment was more often indicated in patients who consulted tardily (17.3% of surgical treatment in patients with time to diagnosis <3 months [OR: 1.09 95% CI: 0.71-2.71] versus 23.8% in patients with time to diagnosis >3 months [OR: 1.82 95% CI: 1.14-2.92]). Verstappen et al 18 have revealed in their study conducted on 482 RA patients that patients in whom csDMARDs were introduced immediately after diagnosis had fewer surgical indications compared to patients treated tardily.…”

Section: Discussionmentioning

confidence: 99%

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Joint Surgery in Tunisian Rheumatoid Arthritis Patients: Prevalence and Risk Factors

Saidane

Gafsi²,

Tekaya

et al. 2019

Arch Rheumatol

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Objectives: This study aims to assess the prevalence of joint surgery in Tunisian patients with rheumatoid arthritis (RA) and to determine the risk factors of surgical treatment. Patients and methods: This retrospective cross-sectional study was performed over a period of 15 years between January 2000 and December 2014 and included 500 Tunisian patients with RA (78 males, 422 females; mean age 53.4 years; range, 21 to 83 years). The prevalence of joint surgery indication was evaluated. Clinical, paraclinical and therapeutic characteristics of RA were compared according to the need of surgery. Results: Female to male ratio was 5. The indication of joint surgery was noted in 59 patients (12%). Knee joint surgery was the most performed surgical procedure (56% of surgical treatment). A decrease in surgery prevalence from 30% in 2004 to 4% in 2013 was noted. Statistical study showed that factors associated with joint surgery were: delayed diagnosis (p=0.037), long RA duration (p=0.017), young onset of RA (p<0.001), presence of joint deformities (p=0.034), presence of osteoporosis (p=0.029), presence of antinuclear antibodies (p<0.001), combination therapy of methotrexate with other conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) (p=0.001), short period of first medical treatment (p=0.012) and high erythrocyte sedimentation rate (ESR) (p=0.027). In multivariate analysis, three factors were independently related to the use of joint surgery: age at disease onset [odds ratio (OR): 2.799 95% confidence interval (CI): 1.49-5.22; p=0.01], high ESR level (OR: 2.807 95% CI: 1.5-5.24; p=0.01) and association of methotrexate with other csDMARDs (OR: 3.500 95% CI: 1.61-7.56; p=0.01). Conclusion: Twelve percent of RA patients needed joint surgical treatment. Predictive factors of surgery were age at disease onset, high ESR level and association of methotrexate with other csDMARDs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Joint Surgery in Tunisian Rheumatoid Arthritis Patients: Prevalence and Risk Factors

Saidane

Gafsi²,

Tekaya

et al. 2019

Arch Rheumatol

View full text Add to dashboard Cite

show abstract

“…In a study of two cohorts of RA patients from the 1980s and 1990s, 20%‐30% of patients became unable to work within three to four years of diagnosis . Disease activity levels and disability have fallen in the last 15 years with more intensive treatment . Despite the advances in therapy, RA is a chronic disease where most patients need some form of DMARD therapy indefinitely.…”

Section: Clinical Features and Epidemiology Of Ra Spa And Ici‐iamentioning

confidence: 99%

“…and disability have fallen in the last 15 years with more intensive treatment. 48,49 Despite the advances in therapy, RA is a chronic disease where most patients need some form of DMARD therapy indefinitely.…”

Section: Common To Have Disability In 2-3 Y If Untreatedmentioning

confidence: 99%

Immune checkpoint inhibitor–induced inflammatory arthritis as a model of autoimmune arthritis

Cappelli¹,

Thomas²,

Bingham³

et al. 2020

Immunological Reviews

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The development of inflammatory arthritis in patients receiving immune checkpoint inhibitor therapy is increasingly recognized due to the growing use of these drugs for the treatment of cancer. This represents an important opportunity not only to define the mechanisms responsible for the development of this immune‐related adverse event and to ultimately predict or prevent its development, but also to provide a unique window into early events in the development of inflammatory arthritis. Knowledge gained through the study of this patient population, for which the inciting event is known, could shed light into the pathogenesis of autoimmune arthritis. This review will highlight the clinical and immunologic features of these entities to define common elements for future study.

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Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Dwivedi,

Cichocki,

et al. 2024

JAMA Surg

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ImportanceRheumatoid arthritis (RA) has severe functional and economic consequences. The implications of the Patient Protection and Affordable Care Act (ACA) and demographic factors for access to surgical treatment are unclear.ObjectiveTo investigate factors associated with time to RA hand surgery, surgical incidence, and cost after implementation of the ACA.Design, Setting, and ParticipantsThis cross-sectional study used insurance data from the IBM MarketScan Research Databases from 2009 through 2020 to compare time to surgery, surgical incidence, and treatment cost for RA of the hand before and after ACA implementations. Included patients were 18 years or older with a new diagnosis for RA of the hand and at least 1 procedural code for arthroplasty, arthrodesis, tenolysis, tendon repair, or tendon transfer. Patients with coexisting inflammatory arthritis diagnoses were excluded. Demographic variables analyzed included patient sex, age at index date, residence within or outside a metropolitan statistical area (MSA; hereafter urban or nonurban), insurance and health plan type, Social Deprivation Index, Elixhauser Comorbidity Index score, and Rheumatic Disease Comorbidity Index. Data analysis occurred from October 2022 to April 2023.ExposuresSurgery for RA of the hand during the pre-ACA (before 2014) vs post-ACA (2014 or later) periods.Main Outcomes and MeasuresTime to surgery, surgical incidence, and cost of treating RA in patients undergoing hand surgery for RA.ResultsAmong 3643 patients (mean [SD] age, 57.6 [12.3] years) who underwent hand surgery for RA, 3046 (83.6%) were women. Post-ACA passage, 595 (86.2%) patients who resided in urban areas had a significantly lower time to surgery than those who did not (−70.5 [95% CI, −112.6 to −28.3] days; P &lt; .001). Among urban patients, the least socially disadvantaged patients experienced the greatest decrease in time to surgery after ACA but the change was not statistically significant. For all patients, greater social disadvantage (ie, a higher SDI score) was associated with a longer time to surgery in the post-ACA period; for example, compared with the least socially disadvantaged group (SDI decile, 0-10), patients in SDI decile 10 to 20 waited an additional 254.0 days (95% CI, 65.2 to 442.9 days; P = .009) before undergoing surgery. Compared with the pre-ACA period, the mean surgical incidence in the post-ACA period was 83.4% lower (162.3 vs 26.9 surgeries per 1000 person-years; P &lt; .001), and surgical incidence was 86.3% lower in nonurban populations (27.2 vs 3.7 surgeries per 1000 person-years; P &lt; .001) but only 82.8% lower in urban populations (135.1 vs 23.2 surgeries per 1000 person-years; P &lt; .001). Per capita total costs of all treatment related to RA of the hand decreased in the post-ACA period but the change was not statistically significant. Insurer-paid costs were lower in the post-ACA period but the change was not statistically significant. Out-of-pocket expenses did not change.Conclusions and RelevanceFindings of this cross-sectional study suggest that after ACA passage, disparities exist in access to timely, cost-effective hand surgery for RA. Increased access to surgical hand specialists is needed for nonurban residents and those with greater social deprivation, along with insurance policy reforms to further decrease out-of-pocket spending for RA hand surgery.

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Trends in Treatment, Outcomes, and Incidence of Orthopedic Surgery in Patients with Rheumatoid Arthritis: An Observational Cohort Study Using the Japanese National Database of Rheumatic Diseases

Cited by 41 publications

References 36 publications

Joint Surgery in Tunisian Rheumatoid Arthritis Patients: Prevalence and Risk Factors

Joint Surgery in Tunisian Rheumatoid Arthritis Patients: Prevalence and Risk Factors

Immune checkpoint inhibitor–induced inflammatory arthritis as a model of autoimmune arthritis

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

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