PHILADELPHIA — The rate of common joint operations in patients with rheumatoid arthritis, notably those aged 40-59 years, has decreased overall during the past 25 years, according to data from a population-based, cross-sectional study.
“Recent studies suggest long-term outcomes of rheumatoid arthritis have been improving. There have been notable decreases in disability as well as damage on x-rays,” said Dr. Grant H. Louie at the annual meeting of the American College of Rheumatology.
In their study of California residents 40 years of age or older with rheumatoid arthritis, Dr. Louie and his coinvestigator Dr. Michael Ward examined age-, sex-, and race-adjusted rates of four types of joint surgery per 100,000 rheumatoid arthritis patients from 1983 to 2007. Data were pooled into 5-year intervals.
The data showed that rates of joint surgery peaked in the 1990s, and since then have decreased.
For all patients aged 40 years or older, the total number of knee replacements fell by 2% between 1983 and 2007; this difference was not significant.
The rate of hip replacement in the overall population increased by 2%, a change that also was not significant, reported Dr. Louie of the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, Md.
However, when the data were stratified by age into older and younger groups, younger rheumatoid arthritis patients (aged 40-59 years) showed a 19% drop in the rate of total knee arthroplasty in 2003-2007, compared with 1983-1987 (adjusted rate ratio 0.81, 95% confidence interval 0.74-0.87, P less than .0001), while a 40% reduction was found for total hip arthroplasty (adjusted rate ratio 0.60; 95% CI 0.54-0.66, P less than .0001) over those same periods.
A 60% drop was noted for ankle surgery (total ankle arthroplasty or arthrodesis), while wrist surgery (total wrist anthroplasty or arthrodesis) fell by 57%.
For rheumatoid arthritis patients aged 60 years or older, the rates of total knee and hip replacement increased by 4% and 26%, respectively, while rates for ankle and wrist surgery significantly decreased.
“Although we can't know for sure the reasons for these declines in the rates, we speculate that one explanation may be improved treatment of rheumatoid arthritis in the last several decades, as well as better understanding of underlying mechanisms of disease,” he said.
Dr. Louie had no conflict of interest disclosures.
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“One explanation may be improved treatment of rheumatoid arthritis,” Dr. Grant H. Louie said.
Source Mitchel L. Zoler/Elsevier Global Medical News