ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 28

The Decrease over Time of Orthopaedic Surgery in Patients with Rheumatoid Arthritis Is Mainly Due to Reduced Rates Among Those with Rheumatoid Factor Positive Disease – Results from a Well Defined Area

Korosh Hekmat1,2, Lennart T.H. Jacobsson3, Jan-Åke Nilsson1, Minna Willim1, Martin Englund4,5, Ingemar F Petersson4 and Carl Turesson6, 1Department of Rheumatology. Malmö University Hospital, Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden, 2Karolinska University Hospital, Department of Medicine, Unit of Rheumatology, Stockholm, Stockholm, Sweden, 3Department of Rheumatology Malmö University Hospital, Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden, 4Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden, 5Clinical Epidemiology Unit, Orthopedics, Dept of Clinical Sciences Lund, Lund University, Lund, Sweden, 6Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ,

Session Information

Date: Sunday, November 8, 2015

Title: Epidemiology and Public Health Poster I: Comorbidities and Outcomes of Systemic Inflammatory Diseases

Session Type: ACR Poster Session A

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

Background/Purpose : Seropositive and seronegative rheumatoid arthritis (RA) differ in course and prognostic feature. The overall incidence of orthopaedic surgery in patients with RA has previously been shown to decline over time. The purpose of this study was to investigate whether there were differences in the time trends for orthopaedic surgery in rheumatoid factor (RF) positive and RF negative RA.

Methods: A population-based dynamic cohort of all known patients with RA in a defined geographic area was investigated. The patients had a clinical diagnosis of RA made by a rheumatologist, and fulfilled the 1987 ACR criteria for RA. Data on orthopaedic surgery procedures between 1998 and 2011 were retrieved from a regional health care register. Incidence rates of orthopaedic surgery procedures after RA diagnosis during the period from 1998 through 2011 were estimated separately for RF positive and RF negative patients. The incidence rates for 1998-2001 were compared to those of 2002-2006 and 2007-2011.

Results: A cohort of 2095 patients with RA (72 % women, 69 % RF positive) was investigated. There were 1702 orthopaedic procedures during a total follow-up of 21,123 person-years (py). Patients with RF positive RA were treated more extensively with methotrexate and biologic disease modifying anti-rheumatic drugs than those with RF negative RA. The incidence of orthopaedic surgery procedures overall declined significantly over time for RF positive RA, and there was a corresponding decline in small joint surgery and large joint surgery (Table). In patients with RF positive RA, the incidence of large joint surgery was reduced already in 2002-2006 compared to 1998-2001, whereas a decline in small joint surgery was apparent only in the final period (2007-2011). The incidence rate ratio (IRR) for orthopaedic surgery overall in this subset compared to 1998-2001 was 0.83 (95% confidence interval (CI) 0.73-0.95) in 2002-2006, and 0.68 (95% CI 0.59-0.79) in 2007-2011. On the other hand there was no significant decline among patients with RF negative RA in the incidence of all orthopaedic surgery procedures, with similar findings for small joint surgery or large joint surgery (Table). In patients with RF negative RA, the IRR for surgery overall compared to 1998-2001 for 2002-2006 was 0.90 (95% CI 0.68-1.18), and for 2007-2011 0.80 (95% CI 0.60-1.06).

Conclusion: The overall incidence of orthopaedic surgery declined over time in patients with RF positive RA, with significant decreases in both large and small joint surgery. In contrast, there was no major decline in RF negative RA. Patients with seropositive RA may benefit more from improved management and modern anti-rheumatic pharmacotherapy in terms of reduction of joint damage and the need for joint surgery.

Incidence of orthopaedic surgery per 1000 py (95 % CI) in the population-based RA cohort

1998-2001

2002-2006

2007-2011

P

RF positive RA

All orthopaedic surgery

114.2

(103.6-125.5)

94.9

(86.6-103.9)

78.1

(70.0-86.8)

<0.0001

Small joint surgery

57.6

(50.2-65.8)

52.2

(46.0-58.9)

36.2

(30.8-42.3)

<0.0001

Large joint surgery

54.7

(47.5-62.7)

41.4

(35.9-47.4)

40.5

(34.8-46.9)

<0.0001

RF negative RA

All orthopaedic surgery

61.4

(49.5-75.3)

55.0

(45.9-65.5)

49.3

(40.6-59.3)

0.12

Small joint surgery

22.0

(15.2-30.9)

21.8

(16.2-28.8)

15.0

(10.4-20.9)

0.10

Large joint surgery

36.0

(27.1-47.0)

32.3

(25.4-40.6)

31.7

(24.8-39.9)

0.49

Disclosure: K. Hekmat, None; L. T. H. Jacobsson, None; J. Nilsson, None; M. Willim, None; M. Englund, None; I. F. Petersson, None; C. Turesson, None.

To cite this abstract in AMA style:

Hekmat K, Jacobsson LTH, Nilsson J, Willim M, Englund M, Petersson IF, Turesson C. The Decrease over Time of Orthopaedic Surgery in Patients with Rheumatoid Arthritis Is Mainly Due to Reduced Rates Among Those with Rheumatoid Factor Positive Disease – Results from a Well Defined Area [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-decrease-over-time-of-orthopaedic-surgery-in-patients-with-rheumatoid-arthritis-is-mainly-due-to-reduced-rates-among-those-with-rheumatoid-factor-positive-disease-ae-results-from-a-well-d/. Accessed .

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