Orthopaedic Intervention May be Necessary Within 5 Years of Rheumatoid Arthritis Onset, Despite Pharmacotherapy

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Orthopaedic Intervention May be Necessary Within 5 Years of Rheumatoid

Arthritis Onset, Despite Pharmacotherapy

A DGReview of : " Orthopaedic intervention in early rheumatoid arthritis.

Occurrence and predictive factors in an inception cohort of 1064 patients

followed for 5 years "

Rheumatology

02/18/2004

By Jill

Joint failure severe enough for orthopaedic intervention may occur within a

few years from the onset of rheumatoid arthritis (RA) despite early use of

conventional medical therapy, according to researchers reporting on behalf

of the Early Rheumatoid Arthritis Study Group (ERAS), United Kingdom.

Progressive joint destruction continues in a subgroup of RA patients

regardless of early and more aggressive treatment. Observational studies are

still required in order to assess prognostic factors, long-term outcomes,

and less common outcomes, such as orthopaedic surgery.

Medical therapy failure and a poor prognosis may be indicated in cases where

orthopaedic surgery is needed as part of RA management. To assess the

frequency and predictive markers for orthopaedic interventions in RA

patients, researchers led by Dr. D. of Princess of Wales

Hospital, Grimsby, followed a large cohort of RA patients over a period of 5

years in 9 regions in England.

A total of 1,236 patients with early RA were enrolled into the study, 33%

were men and 67% were women. The median age of RA onset was 55 years.

Standard clinical and laboratory assessments were performed at baseline and

at yearly intervals for participants throughout the study.

Of the study population, 86% were observed for at least 5 years. During

follow up, 83% of patients received at least 1 disease modifying

antirheumatic drug and 17% received non-steroidal anti-inflammatory drugs

and/or low-dose steroids. Orthopaedic procedures were performed in 17% of

patients, with 4% undergoing 1 or more operations in the wrist, hands, or

feet, and 7% undergoing replacement of multiple large joints.

Risk factors for orthopaedic intervention in the hand or foot joint included

female gender (odds ratio scores [OR] 3.2, 95% confidence interval [CI]

1.3-7.6), joint score (OR 2.3, CI 1.2-4.3), erosions (OR 2.3, CI 1.1-4.8),

disease activity (DAS) (OR 2.4, 1.3-4.5) and Health Assessment Questionnaire

score (OR 1.9, CI 1.0-3.6).

Risk factors at baseline for large joint replacement surgery were a low

haemoglobin concentration (OR 3.4, CI 2.1-5.8) and high scores for

erythrocyte sedimentation rate (OR 3.2, CI 1.8-5.3), DAS (OR 2.1, CI

1.2-3.5), and Larsen X-rays (OR 2.6, CI 1.4-4.8).

Although previously reported as a prognostic marker for major joint

replacement, results of this study indicated that the HLA-DRB1 RA shared

epitope was associated with any type of orthopaedic surgery (OR 1.7, CI

1.1-2.7).

The investigators say that determination of the clinical utility of these

prognostic markers will require further study.

Rheumatology (Oxford) 2004 Jan 13