More RA Drug Therapy, Less Joint Surgery

WEDNESDAY, October 30, 2013 — The use of medications like biologic drugs in patients with rheumatoid arthritis is linked to reduced incidence of orthopedic surgery, according to new research presented at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals in San Diego.
RA occurs when the immune system attacks tissue in joints, causing inflammation. It is a chronic condition that can also affect other organs in the body. RA incidence is two to three times higher in women than men, according to the U.S. Centers for Disease Control.
“We demonstrated a reduced incidence of orthopedic surgery over time,” wrote lead researcher Korosh Hekmat, MD, in an email. Dr. Hekmat is a specialist in internal medicine and rheumatology at Malmö University in Sweden. "Adjustment for age, sex and disease duration had no significant impact on these findings. Women and patients with positive RF [rheumatoid factor] were more likely to require small joint surgery,” he added.
Hekmat and his colleagues looked at the incidence of orthopedic joint surgery performed on 2,342 patients with RA in a specific geographical area. Patient-completed health questionnaires from specific years were paired with data in the Swedish national health registry on biologic drug use records and surgical records. The researchers compared orthopedic surgery incidence rates from 1998 to 2001 to rates from 2002 to 2006 and 2007 to 2011.

The rate of orthopedic surgeries decreased over time. The incidence rate was 94.6 during the years 1998 to 2001, and then 71.8 from years 2007 to 2011. During the study period, the gradual decline in surgeries corresponded with an increased use of pharmacologic drugs for RA, especially biologics. (Researchers didn’t verify whether individual patients were using these drugs.)
The incidence of all orthopedic surgeries for patients with RA was 82.3 out of 1,000 people throughout the entire study period. There were overall declines in large joint (for example, hip) and small joint (hand, wrist, ankle, foot) surgeries, but no declines in knee surgeries.
Female gender was a predictor of surgery and a greater rate of disability was associated with an increased incidence of surgery. Hekmat said he didn’t know why being female was a predictor of surgery, but speculated that one reason could be that women have more severe RA.
“Even though the incidence of orthopedic surgery has declined over time … rheumatoid arthritis is still associated with chronic joint destruction," he said, adding that "the need for orthopedic surgery, especially total joint replacement, is an important severe, long-term outcome for the disease. We need to identify these patients, for example, with simple clinical measures at baseline for better and more aggressive treatment."
This research will help rheumatologists determine which patients may be at risk of or more likely to require orthopedic surgery, Hekmat said.