Session Information
Title: Rheumatoid Arthritis - Clinical Aspects II: Clinical Features & Comorbidity/Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose: Despite improvements in medical management of rheumatoid arthritis (RA) in recent years, arthritis related orthopedic surgery is often needed to relieve pain and improve function. We aimed to identify risk factors for orthopedic surgery in RA, and ascertain if predictors for large joint surgery differ from those for small joint surgery and soft-tissue procedures.
Methods: A population-based inception cohort of patients fulfilling 1987 ACR criteria for RA between 1980-2007 was assembled and followed until death, migration or 12-31-2008. A retrospective medical record review was performed of all orthopedic surgeries since RA incidence, including primary total joint arthroplasty (TJA), large joint surgery (LJS), small joint surgery (SJS) and soft tissue procedures (STP). Demographics, clinical characteristics of RA, extra-articular manifestations and comorbidities were recorded. Risk factors for surgery were examined using Cox models adjusted for age, sex and calendar year.
Results: The study included 813 RA patients (mean age 56 years; 68 % female; mean follow-up 9.6 years), 189 of who underwent ≥1 joint surgeries during follow-up.
Age was associated with a significantly higher risk of TJA (hazard ratio [HR] per 10 years 1.18; p=0.01) and hip/knee surgery (HR 1.3; p<0.001) but lower risk of SJS (HR 0.84; p=0.03). Female sex (HR 1.38; p=0.05) was predictive of a higher risk for any joint surgery. Obesity at incidence was predictive of higher rates of TJA (HR 2.0; p=0.001), LJS (HR=1.8; p=0.001) and hip/knee surgery (HR=2.6; p<0.001), but not SJS (HR=0.8; p=0.4) or STP (HR=1.0; p=0.9). ESR at RA incidence was associated with increased risk for any joint surgery (HR per 10 mm/hr 1.12; p=0.002), TJA (HR=1.2; p<0.001) and LJS (HR=1.15; p=0.001) but not SJS (HR=1.0; p=0.7). Presence of rheumatoid factor (HR=2.0; p<0.001) and radiographic erosions (HR 3.1; p<0.001) predicted a significantly higher risk for any joint surgery.
Large joint swelling was associated with elevated risk of TJA (HR 1.85; p=0.02), LJS (HR 2.1; p=0.001) and STP (HR 2.0; p=0.02) but not SJS. Rheumatoid nodulosis was predictive of SJS (HR 3.3; p<0.001) and STP (HR 3.0; p<0.001) but not LJS (HR=1.3; p=0.2). Severe extra-articular manifestations of RA were marginally associated with a higher risk of SJS (HR 1.8; 95% confidence interval [CI] 0.93-3.6) but not LJS (HR 1.0; p=0.98). Smoking history predicted a marginally higher risk for STP (HR 1.57; 95% CI 0.98-2.5) but not other procedures.
Conclusion: Women with RA are more likely than men to undergo joint surgery. Female sex, increasing age and obesity were predictive of LJS (especially hip and knee TJA) in RA, similar to the general population. Older patients were less likely to undergo SJS. Rheumatoid nodulosis and radiographic erosions are strong predictors especially for SJS and STP but are also associated with increased risk for any joint surgery. These results indicate that need for LJS in patients with RA is similar to the general population, and that SJS is less desirable for older patients despite long standing disease. Aggressive control of disease activity in the early years after RA incidence to lessen development of erosive changes may decrease future need for joint surgery.
Disclosure:
A. Makol,
None;
C. S. Crowson,
None;
E. L. Matteson,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/orthopedic-surgery-among-patients-with-rheumatoid-arthritis-1980-2007-a-population-based-study-to-identify-predictors-of-large-joint-vs-small-joint-surgeries/