RESEARCH - Joint surgery in the Utrecht RA cohort: the effect of treatment strategy

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Ann Rheum Dis. 2006 May 5; [Epub ahead of print]

Joint surgery in the Utrecht rheumatoid arthritis cohort: The effect of

treatment strategy.

Verstappen SM, Hoes JN, Ter Borg EJ, Bijlsma JW, Blaauw AA, van

Albada-Kuipers GA, van Booma-fort I, s JW.

University Medical Center Utrecht, Netherlands.

OBJECTIVE: To investigate the prevalence and prognostic factors of joint

surgery in a large cohort of patients with rheumatoid arthritis (RA) of whom

treatment, clinical, and radiographic data have been assessed at predefined

points in time since disease onset. METHODS: Data on surgical interventions

were retrospectively obtained of 482 RA-patients of whom at least 2 year

follow-up data were available including treatment and response to treatment

during the first two years. Survival time until the first and until the

first major surgical intervention was determined for the total study

population by Kaplan Meier survival curves. In three separate regression

analyses, we also analyzed which variables measured at baseline, during the

first year, and during the first two years were predictors for joint

surgery. RESULTS: In the total study population, 27% of patients underwent

surgical interventions. Mean survival time until the first surgical

intervention was 10.4 years. The percentage of patients with a surgical

intervention was 10% lower in the response to treatment group when compared

to the non-response group. Next to a delayed start with DMARDs, fast

radiographic progression during the first and first two years was a

predictor of joint surgery in the multivariate regression analyses.

CONCLUSION: Treatment with DMARDs immediately after diagnosis results in

less joint surgery when compared to a delayed start. Furthermore, joint

surgery occurs more frequently in patients who do not respond to therapy.

PMID: 16679433

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6679433

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