Newswise — The rates of joint surgery in patients with rheumatoid arthritis peaked in the 1990s and have been declining ever since – suggesting that long-term outcomes are improving for these patients, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Philadelphia, Pa.
Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.
Treatment of RA has greatly improved over the last 25 years, and researchers recently examined the rates of total knee replacement and other joint surgeries to determine if they have decreased in amount over time.
Researchers—with support of the Intramural Research Program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health—recently studied a group of California residents who were at least 40 years old and had RA to look at the trends in the rates of total knee, total hip, total ankle (or arthrodesis), and total wrist replacement each year between 1983 and 2007. They adjusted the information received based on age, sex and race and pooled all of the information into five-year intervals to provide a better estimate of the rates of these surgeries over time.
Researchers found that rates of joint surgery increased in the 1990s and have since decreased. More specifically, they found that among patients ages 40 to 59 years, the rates of total knee replacement from 2003-2007 were 19 percent lower than in 1983-1987, while rates of total hip replacement in the same time period had dropped by 40 percent. Additionally, they found that rates of total knee and hip replacement did not decrease in patients who were 60 years or older, but had increased four and 26 percent, respectively; however, similar trends were observed in the general population. Researchers also found, when compared to rates in the mid-1980s, rates of ankle and wrist surgery in the mid-2000s had significantly decreased in both age groups. For all four procedures, trends were found to be similar among men and women.
“We discovered that patients with RA, particularly those of younger age, are having fewer common joint replacement surgeries now than over the previous decade or so,” explains Grant H. Louie, MD, MHS; Lawrence E. Shulman Scholar, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md. and lead investigator in the study.
“Although the precise reasons for this finding are not entirely certain, we hypothesize that recent advances in treatment of this physically disabling disease may play a role. Rheumatologists have made significant strides during the past 25 years in reducing irreversible joint damage caused by chronic inflammation through combining existing therapies, developing more effective and safer medications that specifically target the drivers of inflammation, and identifying and treating patients earlier in the disease course. Time will tell, but I am cautiously optimistic that the trends we are seeing now may very well continue in the years ahead.”
The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see www.rheumatology.org/annual.
Editor’s Notes: Dr. Louie will present this research during the ACR Annual Scientific Meeting in Salon E of the Philadelphia Marriott Downtown at 5:30 PM on Monday, October 19. Dr. Louie will be available for media questions and briefing at 8:30 AM on Monday, October 19 in the on-site press conference room, 109 A.
Presentation Number: 1248
Changes in the Rates of Joint Surgery Among Patients with Rheumatoid Arthritis in California, 1983-2007
Grant H. Louie, MD, MHS, Bldg 10 CRC Rm 4-1339, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD Michael M. Ward, MD, MPH , Bldg 10 CRC Rm 4-1339, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD
Purpose: Treatment of rheumatoid arthritis (RA) has improved markedly over the past 25 years. We previously reported that rates of total knee arthroplasty, a long-term sequela of poorly-controlled RA, decreased among patients with RA in California in 1998-2001 after peaking in the 1990s. Because it is uncertain whether these rates have continued to decrease, we examined rates of total knee arthroplasty through 2007, and investigated whether rates of other joint surgery decreased between 1983 and 2007.
Methods: In this population-based, serial cross-sectional study of California residents aged 40 years and older with RA, we analyzed 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. We computed age-, sex-, and race-adjusted rates of joint surgery and pooled data in 5-year intervals to provide more stable estimates of rates. We used Poisson regression models to compare changes in adjusted rates across time periods, and performed stratified analyses by age and sex.
Results: Rates of joint surgery peaked in the 1990s and since have decreased (Table). Among patients aged 40-59 years, rates of total knee arthroplasty 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 total hip arthroplasty in 2003-2007 were 40% lower than in 1983-1987 (adjusted rate ratio 0.60; 95% CI 0.54 – 0.66, P < 0.0001). Rates of total knee arthroplasty and total hip arthroplasty in 2003-2007 did not decrease in patients aged ≥ 60 years but increased by 4% (P = 0.19) and 26% (P < 0.0001), respectively. Similar trends were 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. For all four procedures, trends were similar in men and women.
Table(View the press release with full abstract at www.rheumatology.org).
Conclusion: Rates of joint surgery in patients with RA peaked in the 1990s and have declined thereafter, suggesting that long-term outcomes of RA are improving.
Disclosure: G. H. Louie, None; M. M. Ward, None.
RSS