ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1060

Musculoskeletal Surgeries and Procedures in Patients with RA: Results from a UK Retrospective Study

H Cawston1, F Bourhis1, T Le2 and E Alemao3, 1OptumInsight, Nanterre, France, 2Bristol-Myers Squibb, Hopewell, NJ, 3Bristol-Myers Squibb, Princeton, NJ

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Epidemiology and Public Health (ACR): Rheumatoid Arthritis and Systemic Lupus Erythematosus Outcomes

Session Type: Abstract Submissions (ACR)

Background/Purpose: Musculoskeletal surgeries and procedures substantially improve the quality of life of patients with RA, but represent an important burden in terms of medical costs. The aim of this study was to assess whether recent advances in RA treatment had an impact on long-term surgery rates in the UK. Methods: A retrospective cohort study was conducted from 1997 to 2010, using Clinical Practice Research Database General Practice Online Data (GOLD) and Hospital Episode Statistics (HES) data. RA population was defined as all patients presenting with one or more RA read code after 01/01/1988 (index code), with no RA or juvenile RA codes before the RA index code. Patients were required to have a minimum of 12 months of data before the first RA code and to have no psoriatic arthritis-related codes over the entire period. Date of onset of disease was defined as date of first RA-related code. RA patients were matched 4:1 to non-RA patients based on their year of entry in the GOLD database, cardiovascular (CV) risk category (NCEP classification), CV treatment status, and a risk score measuring the probability of having RA. The index code of non-RA patients was defined as the date of observation closest to the index code of their matched RA patient. Surgeries such as total joint arthroplasties (TJA), non-TJA, TJA-associated procedures, as well as other orthopedic procedures were identified in HES and GOLD databases using operating procedure codes and read codes. Incidence rates (IRs) were estimated over the study period and by time since diagnosis in both cohorts. Time-to-first-surgery curves in all RA patients as well as stratified by terciles of CRP measured at diagnosis were based on Kaplan–Meier (KM) estimates. Results: Overall, 14,181 patients with RA were identified and matched to 49,935 non-RA patients. IRs in RA patients, relatively constant up to 2003, sharply increased in 2004 (IR=4.0/100 person-years; 95% CI: 3.5, 4.3) before a steady decrease was observed up to 2006 (3.1 [2.8, 3.5]). This trend was driven by TJAs, for which an IR of 2.7 (2.3, 3.0) was observed in 2010. Majority of TJAs involved the knee (43.5%) and hip (40.2%). However, IRs of all surgeries increased from 0.1 (0.0, 0.2) to 1.4 (1.3, 1.6) from 1997 to 2010 in non-RA patients. Based on the KM analysis, the probabilities of having a surgery at 3, 5 and 10 years were 5.5%, 8.6% and 17.3%, respectively. Patients in the higher tercile of CRP at diagnosis were at higher risk of first surgery than the two lower terciles (log-rank test between three groups: p=0.0007).

Conclusion: Decrease in the IRs of musculoskeletal surgeries in 2005/2006 could be attributed to greater availability of biologic therapies. However, these rates have not decreased in recent years, suggesting there is an unmet need for more effective therapies. CRP levels at diagnosis were associated with higher risk of surgeries, suggesting that therapies reducing CRP may be effective to further lower surgical rates. 66572e Figure 1  

Disclosure:

H. Cawston,

OptumInsight,

3,

Bristol-Myers Squibb,

5;

F. Bourhis,
None;

T. Le,

BMS,

3;

E. Alemao,

Bristol-Myers Squibb,

1,

Bristol-Myers Squibb,

3.

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