Decrease in the incidence of total hip arthroplasties in patients with rheumatoid arthritis - results from a well defined population in south SwedenReport as inadecuate




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Arthritis Research and Therapy

, 13:R67

First Online: 21 April 2011Received: 17 November 2010Accepted: 21 April 2011

Abstract

IntroductionOne aim of modern pharmacologic treatment in rheumatoid arthritis RA is to prevent joint destruction and reduce the need for surgery. Our purpose was to investigate secular trends in the incidence of primary total hip and knee arthroplasties in a well defined sample of patients with RA.

MethodsPrevalent cases with RA in 1997 and incident cases from 1997 to 2007 in a community based register in Malmö, south Sweden, were included. Based on a structured review of the medical records, patients were classified according to the 1987 ACR criteria for RA. This cohort was linked to the Swedish Hip Arthroplasty Register through December 2006 and the Swedish Knee Arthroplasty Register through October 2007. Patients with a registered total hip or knee arthroplasty before 1997 or before RA diagnosis were excluded. Incidence rates for the period of introduction of TNF inhibitors 1998 to 2001 were compared to the period when biologics were part of the established treatment for severe RA 2002 to 2006-2007.

ResultsIn the cohort n = 2,164; 71% women a primary hip arthroplasty was registered for 115 patients and a primary knee arthroplasty for 82 patients. The incidence of primary total hip arthroplasties decreased from the period 1998 to 2001 12.6-1,000 person-years pyr to 2002 to 2006 6.6-1,000 pyr rate ratio RR 0.52; 95% confidence interval CI 0.35 to 0.76. There was a trend towards an increase of primary knee arthroplasties incidence 4.8-1,000 pyr vs. 6.8-1,000 pyr; RR 1.43; 95% CI 0.89 to 2.31.

ConclusionsOur investigation shows a significant decrease in the incidence of total hip arthroplasties in patients with RA after 2001. Possible explanations include a positive effect on joint damage from more aggressive pharmacological treatment.

AbbreviationsACRAmerican College of Rheumatology

CIconfidence interval

DMARDsdisease-modifying anti-rheumatic drugs

ICDInternational Classification of Diseases

pyrperson-years

RArheumatoid arthritis

RRrate ratio

THAtotal hip arthroplasties

TKAtotal knee arthroplaties

TNFtumor necrosis factor

Electronic supplementary materialThe online version of this article doi:10.1186-ar3328 contains supplementary material, which is available to authorized users.

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Author: Korosh Hekmat - Lennart Jacobsson - Jan-Åke Nilsson - Ingemar F Petersson - Otto Robertsson - Göran Garellick - Carl Tur

Source: https://link.springer.com/







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