Treating rheumatoid arthritis patients with intensive pharmacological agents, such as biologic drugs, may reduce the need for orthopedic joint surgery, according to research presented this week at the American College of Rheumatology Annual Meeting in San Diego.
Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.
Researchers based in Malmö, Sweden, looked at the incidence of any type of orthopedic joint surgery performed in Sweden on a total of 2,342 people with RA who fulfilled the 1987 ACR criteria for the disease. Of these, 68.7 percent were female. Patients drawn from RA patient registries from the years 1997, 2002, 2005 and 2009, were sent questionnaires to assess their general health and pain levels. Between 62 and 74 percent of RA patients contacted responded to the survey. Patient questionnaire responses were linked to the Swedish national health registry records to correlate the data with records of inpatient and outpatient surgeries, as well as use of biologic drugs. The incidence rate of orthopedic joint surgeries in this population from 1998 to 2001 was compared to the rates in the 2002 to 2006 and 2007 to 2011 time periods.
The researchers conducted the study to determine "whether the incidence of orthopaedic surgery is declining over time in patients with RA, and whether patient-reported outcomes predict the need for such procedures in future," according to Korosh Hekmat, MD; specialist in internal medicine rheumatology and PhD fellow; Malmö University; and the lead author on the study.
Incidence of all orthopedic surgeries for RA patients from 1998 to 2011 was 82.3 out of 1,000 people, but the researchers noticed significant declines over the time periods studied. In the 1998 to 2001 time period, there was a 94.6 incidence rate, while in the 2007 to 2011 time period, there was a 71.8 incidence rate. Decreases were noted in both large joint (hips) and small joint (hands, wrists, feet and ankles) surgeries. Knee surgeries did not show a decline. Factors that increased the incidence of joint surgery were female gender and a higher rate of disability according to standard Health Assessment Questionnaire scores.
The time period studied coincided with increased use of early pharmacologic intervention in RA cases, especially with biologic drugs, although the researchers did not confirm the patients were using these drugs. Using these drugs early in the RA disease process may help halt inflammation and the joint erosion it can cause, thus preventing the need for orthopedic surgery the study's authors concluded.
"Our study suggests that the rate of orthopedic surgery was reduced by early intensive treatment in patients with severe RA," says Dr. Hekmat. Patients should talk to their rheumatologists to determine their best course of treatment.
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