Background/Purpose: Hip or pelvis fractures (HOP) are common osteoporotic fractures (OP) with significant risks of medical complications, placement into care, reduced quality of life and death. Rheumatoid arthritis (RA), is a chronic autoimmune condition which poses challenges in orthopaedics due to its association with immunological deficits, OP, multiple comorbidities, and polypharmacy.

Methods: We completed a 2:1 matched cohort study of RA at time of first-fracture, using the WA Rheumatic Disease and Epidemiology Registry (1980-2015) and international classification of disease codes. Primary outcomes is death after HOP .

Results: 471 controls (83% female) and 234 RA (78% female), with mean age at HOP of 79.3 (95% CI 78-80.6) RA and 81.2 (95% CI 80.5-82.0) controls were included. RA is not associated with worse 30-day survival after HOP (HR 0.95, 95% CI 0.52-1.73, p=0.87), but is at 5-years HR 1.23 (95% CI 1.05-1.43, p< 0.01). Similarly, later decade (2000-2010 vs 1990-2000) is not associated with worse survival after HOP in RA (HR 1.18, 95% CI 0.87-1.60, p=0.30), but is in controls (HR 1.49, 95% CI 1.21-1.84, p< 0.01). The lack of association with worse survival at 30 days may suggest early complications secondary to RA are not contributing to increased mortality after HOP. Between 1990-2010 post HOP survival  worsened in controls but not in RA patients, suggesting improved RA management may be offsetting survival reductions.

Conclusion: Improvements in peri-HOP care for RA patients appear to have offset reduced survival. Further research into specific causes of death and reasons for reduced survival in the similarly matched multi-morbid population is needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improvements-in-peri-fracture-care-in-rheumatoid-arthritis-ra-have-offset-increased-mortality/