Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Mortality Outcomes amongst Patients with Rheumatiod Arthritis with and without Joint Surgery: A Comparative Study.
Shourt1, Courtney A., Crowson2, Cynthia S., Gabriel3, Sherine E., Matteson4, Eric L.
Department of Medicine, Mayo Clinic College of Medicine
Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic College of Medicine
Division of Epidemiology, Department of Health Science Research, and Division of Rheumatology, Mayo Clinic College of Medicine
Division of Rheumatology, Mayo Clinic College of Medicine
To examine the association between joint surgery and mortality in patients with rheumatoid arthritis (RA).
A retrospective medical record review was performed of all cases of adult onset RA incident from a defined geographic population base who fulfilled criteria for RA in 19802007. The arthritis related surgeries included in the study were primary total joint arthroplasty (TJA), joint reconstructive procedures (JRP), soft tissue procedures (STP) and revision arthroplasty. Cox models with time-dependent covariates for surgery occurring during follow-up were used to examine the influence of surgery on mortality.
The study included 814 RA patients (mean age: 56 years; 68% female) with mean follow-up of 9.6 years, during which 204 died. A total of 190 patients underwent >=1 surgical procedures involving joints during follow-up. The presence of any joint surgery was significantly associated with mortality (hazard ratio [HR]: 1.4; 95 % confidence interval [CI]:1.01, 1.96; p= 0.04) compared to patients not requiring joint surgery. This association was more pronounced among patients with JRP (HR: 2.77; 95% CI: 1.85, 4.14; p < 0.001). Following additional adjustment for risk factors known to be associated with mortality in RA patients (age, sex, calendar year, body mass index, smoking, rheumatoid factor positivity, severe extra-articular manifestations, comorbidities [cardiovascular disease, renal disease, liver disease, dementia, cancer, alcohol abuse] and use of glucocorticoids), the mortality risk associated with any joint surgery was somewhat attenuated (HR: 1.37; 95% CI: 0.96, 1.97; p=0.08), but the association with JRP persisted (HR: 2.86; 95% CI: 1.89; 4.33; p<0.001).
Overall, there were significant differences in survivorship in patients with RA undergoing joint surgeries compared to patients who did not require joint surgery, especially among patients with JRP. This association persisted following adjustment for known risk factors for mortality possibly indicating a higher disease burden in these patients.
To cite this abstract, please use the following information:
Shourt, Courtney A., Crowson, Cynthia S., Gabriel, Sherine E., Matteson, Eric L.; Mortality Outcomes amongst Patients with Rheumatiod Arthritis with and without Joint Surgery: A Comparative Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1550