Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Decrease of Hip Replacement Surgery in Patients with Rheumatoid Arthritis - Results From a Well Defined Population in Southern Sweden

Hekmat1,  Korosh, Jacobsson1,  Lennart TH, Nilsson1,  Jan-Åke, Petersson2,  Ingemar F., Robertsson2,  Otto, Garellick3,  Göran, Turesson1,  Carl

Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden,
Orthopedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden,
Department of Orthopaedics, Swedish Hip Arthroplasty Register, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Purpose:

Major joint arthroplasty is used effectively in many patients with severe rheumatoid arthritis. The aim of modern pharmacologic treatment is to prevent joint destruction and reduce the need for orthopedic surgery. The purpose of our study was to investigate trends in the incidence of primary total hip and knee replacements in a well defined sample of patients with RA.

Method:

Patients were recruited from a community based register established in 1997, which includes patients from a single University Clinic and collaborating private practitioners. Prevalent cases of RA in 1997 and incident cases 1997–2007 were included. Based on a structured review of the medical records, patients were classified according to the 1987 American College of Rheumatology criteria, and the year of RA diagnosis was noted. The incidence of major joint arthroplasty was estimated based on linkage of this cohort with the Swedish National Hip Arthroplasty (through December 2006) and the Swedish Knee Arthroplasty Register (through October 2007). During the study period, indications for joint replacement in Sweden were based on objective clinical and radiographic findings and were relatively stable across different clinics, although minor changes over time can not be excluded. Patients with a registered hip or knee arthroplasty before 1997 or before RA diagnosis were excluded. The incidence rate for the period at and just after the time of the introduction of TNF inhibitors (1998–2001) was compared to the period when biologics were part of the established treatment for severe RA (2002–2006 for hip replacements and 2002–2007 for knee replacements).

Results:

There were 2164 patients in the cohort (1545 women, 619 men; mean age at diagnosis 51 years). During the study period, a primary hip arthroplasty was registered for 115 patients and a primary knee arthroplasty for 85 patients. The incidence of primary hip arthroplasties decreased from the period 1998–2001 [12.6/1000 person-years(pyr)] to 2002–2006 (6.6/1000 pyr) [rate ratio (RR) 0.52; 95% confidence interval (CI) 0.35–0.76 for 2002–2006 vs. 1998–2001] There was a trend towards an increase of the incidence of primary knee arthroplasty (4.8/1000 pyr 1998–2001 vs. 6.8/1000 pyr 2002–2007 – RR 1.43; 95% CI 0.89–2.31).

Conclusion:

Our investigation shows a significant decrease in hip replacement surgery in patients with RA after 2001. Possible explanations include an effect on joint damage from more aggressive treatment with DMARDs and biologics. The trend towards an increase of knee arthroplasty may be due to changing indications for surgery. Alternatively, destruction of hip and knee joints in RA may be partly due to distinct mechanisms.

To cite this abstract, please use the following information:
Hekmat, Korosh, Jacobsson, Lennart TH, Nilsson, Jan-Åke, Petersson, Ingemar F., Robertsson, Otto, Garellick, Göran, et al; Decrease of Hip Replacement Surgery in Patients with Rheumatoid Arthritis - Results From a Well Defined Population in Southern Sweden [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1249
DOI: 10.1002/art.26323

Abstract Supplement

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