RESEARCH - Orthopaedic surgery in RA patients over 20 years: prevalence and predictive factors of large joint replacement

January 15, 2008

Ann Rheum Dis. 2008 Jan 4 [Epub ahead of print]

Orthopaedic surgery in rheumatoid arthritis patients over 20 years.

Prevalence and predictive factors of large joint replacement.

Kapetanovic MC, Lindqvist E, Saxne T, Eberhardt K.

Dept of Rheumatology, Lund University Hospital, Lund, Sweden.

Purpose: To study the prevalence of orthopaedic surgery and to evaluate

possible predictive factors for large joint replacements in patients with

early RA. PATIENTS AND METHODS: A cohort of 183 patients with early RA was

monitored for 16-20 years after recruitment in 1985-89. There were 116

(63.7%) women. Mean (SD) age was 51.4 (12.4) years and mean (SD) duration of

symptoms before inclusion was 12 (7) months The mean (SD) follow up duration

of all patients included in this study was 16 (4) years. Occurrence of

orthopaedic surgery was recorded continuously. A first prosthesis of a large

joint (shoulder, elbow, wrist, hip, knee or ankle) was used as outcome

variable in the predictive analyses. RESULTS: In total, 386 orthopaedic

interventions were performed in 106/183 (58%) patients during the follow up

and first large joint replacement was performed in 44/183 (24%) patients.

Using regression model HAQ, CRP, ESR at inclusion and radiographic

changes in small joints after 1 year were found associated with increased

risk of receiving prosthesis of large joints.

CONCLUSION: In this cohort of RA patients monitored from early disease

stage, orthopaedic surgical procedures were performed in more than half of

the patients. This included large joint replacements in 24% of the cases.

Easily available measures were identified as predictors of such joint

replacements. This study could serve as a reference for comparison with

cohorts of RA patients recruited today in which new more efficacious

treatment modalities are used.

PMID: 18178691

178691

Not an MD

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