ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 2131

An Evaluation of Prognostic Factors for Orthopaedic Joint Surgery in Rheumatoid Arthritis. Results From Two Multicentre UK Inception Cohorts (1986-2011)

Elena Nikiphorou1, Lewis Carpenter2, Sam Norton3, David James4, Patrick D. Kiely5, David Walsh6, Richard Williams7 and Adam Young3, 1Research Department of Epidemiology & Public Health, UCL and Rheumatology Department, St Albans City Hospital, ERAS, St Albans City Hospital & University College London (UCL), London, United Kingdom, 2Centre for Lifespan & Chronic Illness Research, University of Hertfordshire, Hatfield, United Kingdom, 3Rheumatology, ERAS, St Albans City Hospital, St Albans, United Kingdom, 4Rheumatology, Diana Princess of Wales Hospital, Grimsby, United Kingdom, 5Rheumatology Dept, St. Georges Hospital, London, United Kingdom, 6Academic Rheum/Clin Sci Bldg, City Hospital, Nottingham, United Kingdom, 7Rheumatology, County Hospital, Hereford, United Kingdom

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: anti-TNF therapy, DMARDs, orthopaedic and rheumatoid arthritis (RA)

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Title: Rheumatoid Arthritis - Clinical Aspects III: Infections/Risk Factors for Incident Rheumatoid Arthritis/Metrology/Classification/Biomarkers/Predictors of Rheumatolid Arthritis Activity & Severity

Session Type: Abstract Submissions (ACR)

Background/Purpose: The need for orthopaedic surgery in Rheumatoid Arthritis (RA) is the result of failed medical treatment and a surrogate marker for joint destruction. Reliable prognostic markers are currently limited but have a potential role in guiding clinicians in early management decisions.

Methods: Standardised clinical, laboratory and X-ray measures were performed at baseline, prior to DMARD therapy and then yearly in both the Early RA Study (ERAS, n=1465, 1986-1998) and Early RA Network (ERAN, n=1236, 2002-2011), median follow up 18 and 6 years respectively, maximum 25 years. Treatment of patients included disease modifying, steroid and biologic therapies according to standard UK practices for management of hospital based RA patients. Source data of all orthopaedic interventions included clinical datasets (patient reports and medical records from 1986) and national data: Hospital Episode Statistics and the National Joint Registry. Length of follow up was based on the National Death Registry. For analysis, interventions were grouped into major (total large joint replacements), intermediate (mainly synovectomies, arthroplasties and fusion procedures of wrist, hand, hind/forefoot), and minor (mainly soft tissue and tendon surgery).

Results: 1602 procedures were performed in 770 out of 2701 patients (29%).  576 were large joint replacements (mainly of hips and knees) in 354 (out of 2701) patients (13%), 392 intermediate in 221 (8%), 552 minor in 361 (13%), 55 internal fixations for hip fracture in 53 (2%), 9 cervical spine fusions and the remainder were miscellaneous/not classified procedures. 232 (8.6%) patients had more than one major and/or intermediate procedure.  1255 had minimum 10 year follow up (46%) of whom 531 (42%) had orthopaedic surgery.  In univariate analysis, baseline and 1 year Health Assessment Questionnaire (HAQ), Erythrocyte Sedimentation Rate (ESR), high Disease Activity Scores (DAS), erosions and low haemoglobin(HB) all predicted major and intermediate surgery with odds ratios (ORs) all significant around 1.5-2, but these variables were not predictive of minor surgery.  Strongest predictors for major surgery were low HB (OR 2.6, 95% CI 2-3.3), high Body Mass Index (BMI) only for total knee replacements (OR 1.7, 95% CI 1.2-2.4), for intermediate surgery were women (OR 3.2, 95% CI 2.21-4.7), DAS (OR 3.8, 95% CI 2.1-7.0) and RA related shared epitope (SE, OR 1.6, 95% CI 1.0-2.4). For multiple surgery, strongest predictors were erosions (OR 2.7, 95% CI 1.6-4.3), HAQ (OR 2.6, 95% CI 1.6-4.2), HB (OR 3.4, 95% CI 2.3-4.9), ESR (OR 3.1, 95% CI 1.9-4.7), SE (OR 1.9, 95% CI 1.2-3.4), ESR (OR 3.3, 95% CI 2.3-4.8). In Cox regression, sex, onset age and erosions predicted intermediate surgery, and sex, onset age and HB predicted major surgery. 

Conclusion: Orthopaedic surgery is an important and common outcome in RA, not often reported and difficult to predict. HB does not normally perform well as a predictor of outcome in RA, but did for orthopaedic intervention, especially major and multiple surgery.


Disclosure:

E. Nikiphorou,
None;

L. Carpenter,
None;

S. Norton,
None;

D. James,
None;

P. D. Kiely,
None;

D. Walsh,
None;

R. Williams,
None;

A. Young,
None.

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-evaluation-of-prognostic-factors-for-orthopaedic-joint-surgery-in-rheumatoid-arthritis-results-from-two-multicentre-uk-inception-cohorts-1986-2011/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology