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Abstract Number: 1530

Temporal Trend of Total Joint Replacement in Rheumatoid Arthritis Patients: A Survival Study

Luis Rodriguez-Rodriguez1, José Ivorra-Cortes2, Leticia León3, Benjamín Fernández-Gutiérrez1, Lydia Abasolo4 and Isidoro Gonzalez-Alvaro5, 1Department of Rheumatology, Hospital Clinico San Carlos, Madrid, Spain, 2Rheumatology, University Hospital la Fe, Valencia, Spain, 3Rheumatology, Department of Rheumatology, Hospital Clinico San Carlos, Madrid, Spain, 4Rheumatology Department and Heath Research Institute (IdISSC), Hospital Clinico San Carlos, Madrid, Spain, 5Rheumatology, Rheumatology Service, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: rheumatoid arthritis (RA) and total joint replacement

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Session Information

Date: Monday, November 14, 2016

Session Title: Rheumatoid Arthritis – Clinical Aspects - Poster II: Co-morbidities and Complications

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose : To analyze the temporal trend of incidence rate (IR) of hip and/or knee total joint replacement in a cohort of rheumatoid arthritis (RA) patients

Methods : We performed a retrospective longitudinal study, including patients diagnosed of RA between 1994 and 2009, according to the 1986 ACR diagnostic criteria, attending the rheumatology outpatient clinic of the Hospital Clínico San Carlos (Madrid, Spain). Clinical records were reviewed in order to collect demographic and clinical information. Our main outcome was total hip or knee replacement surgery, considering only the first replacement per joint (multiple event variable). In order to ensure a similar maximum follow-up time for all included patients, regardless the moment when they were included, time of observation comprised only the first 5 year after RA diagnosis (from such date until both knees and hips were replaced, lost of follow-up or 5 years had elapsed). Total joint replacement (TJR) IR was expressed per 1000 patients-year. Kaplan Meier curves were set to account for all TJRs. Cox bivariate and multivariate regression models were constructed to assess the effect of calendar time, demographic and clinical-related variables in the IR. Three time intervals were considered, defined by the year of RA diagnosis: 1994-1999, 200-2004, and 2005-2009. Statistical analyses were performed using STATA v12.

Results : We included 1812 patients, 74% women, with a median (interquartile range) age at RA diagnosis of 60.4 (47.6-71.8) years, 85% Spaniards, 65% with rheumatoid factor (FR), and 48% with anti-citrullinated peptides antibodies (ACPA). 526 patients had been diagnosed between 1994-1999, 551 between 2000-2004 and 735 between 2005-2009. 69 total joints (25 hips and 44 knees) were replaced during a follow-up time of 7522.0 patients-years, resulting in an IR of 9.2 [7.2 to 11.6] per 1000 patients-year. We observed an incidence rate for the time periods 1994-99, 2000-04, and 2005-09 of 10.8 [7.3 to 16.2], 10.5 [7.4 to 15.7], and 6.9 [4.5 to 10.6], respectively (Figure 1). In the bivariate analysis, only age at RA diagnosis showed a significant association with a higher risk of TJR (p=1.0×10-4). In the multivariate analysis (adjusted by sex, age at RA diagnosis, country of birth, presence of ACPA and FR), year of RA diagnosis was not associated with the rate of TJR (2000-2004 vs. 1994-1999: HR 0.97 [95%CI: 0.55 to 1.71], p=0.91; 2005-2009 vs. 1994-1999: HR 0.67 [95%CI: 0.37 to 1.21], p=0.18).

Conclusion : Although we observed that patient diagnosed with RA more recently had a smaller rate of TJR in our RA cohort, differences were not statistically significant. Table 1: Baseline demographic and clinical characteristics of the RA patients included in this study.

Variables

n = 1812

Women, n (%)

1337 (73.8)

Age of RA diagnosis, median (IQR)

60.4 (47.6 to 71.8)

Elapsed time from RA symptoms onset to diagnosis in years, median (IQR) 1.0 (0.3 to 4.6)
Follow-up time in years, median (IQR)

5 (4.1 to 5)

Presence of Rheumatoid Factor, n/N (%)

1152/1780 (64.7)

Presence of ACPA, n/N (%)

482/1002 (48.1)

Spaniard, n (%):

1534 (84.7)

Year of RA diagnosis, n (%):

1994 – 1999

526 (29.0)

2000 – 2004

551 (30.4)

2005 – 2009

735 (40.6)

ACPA: Anti Citrullinated peptide antibodies, IQR: Interquartile range, RA: Rheumatoid arthritis.


Disclosure: L. Rodriguez-Rodriguez, None; J. Ivorra-Cortes, None; L. León, None; B. Fernández-Gutiérrez, None; L. Abasolo, None; I. Gonzalez-Alvaro, None.

To cite this abstract in AMA style:

Rodriguez-Rodriguez L, Ivorra-Cortes J, León L, Fernández-Gutiérrez B, Abasolo L, Gonzalez-Alvaro I. Temporal Trend of Total Joint Replacement in Rheumatoid Arthritis Patients: A Survival Study [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/temporal-trend-of-total-joint-replacement-in-rheumatoid-arthritis-patients-a-survival-study/. Accessed February 2, 2023.
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