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

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Ann Rheum Dis. Published Online First: 4 January 2008.

doi:10.1136/ard.2007.086710

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Extended Report

Orthopaedic surgery in rheumatoid arthritis patients over 20 years.

Prevalence and predictive factors of large joint replacement

Meliha C. Kapetanovic 1*, bet Lindqvist 1, Tore Saxne 1 and Kerstin

Eberhardt 1

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

Abstract

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.

http://ard.bmj.com/cgi/content/abstract/ard.2007.086710v1?papetoc

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