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.
Trends in Orthopedic Surgery Utilization among Patients with Rheumatoid Arthritis: A Focus on Surgery Type and Gender.
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 Science 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, and Division of Epidemiology, Mayo Clinic College of Medicine
To describe current trends in arthritis related orthopedic surgery utilization amongst a population based cohort of patients with rheumatoid arthritis (RA).
A retrospective medical record review was performed of all incident cases of adult onset RA from a defined geographic population base who fulfilled criteria for RA in 19802007. Orthopedic surgeries occurring after the incidence date were recorded, including primary total joint arthroplasty (TJA), joint reconstructive procedures (JRP), soft tissue procedures (STP) and revision arthroplasty, classified according to joint involved (hip, knee, wrist, shoulder, elbow, hand, ankle, foot, cervical spine and temporomandibular). Cumulative incidence of surgery was estimated using Kaplan-Meier methods. Time trends and gender differences were examined using Cox models.
The study included 814 RA patients (mean age: 56 years; 68% female; mean follow-up 9.6 years). A total of 190 patients underwent >=1 surgical procedures involving joints during follow-up. The cumulative incidence of any joint procedure at 10 years for 19801994 was 30.4% compared to 21.9% for 19952007 (p=0.08). The cumulative incidence of all joint surgeries was lower in the 19952007 cohort compared to the 19801994 cohort, with the greatest reduction in soft tissue procedures (synovectomies, tendon repairs, tendon transfers, meniscus repair, ligament release, cartilage repair), which decreased from 13.4% in 19801994 to 7.3% in 19952007 at 10 years after RA incidence (p=0.018). Knee surgeries were less common in patients diagnosed in 19952007 compared to those diagnosed in 19801994 (hazard ratio [HR]: 0.56; p=0.045), as were hand surgeries (HR: 0.45; p=0.059), but there was no change in hip surgeries (p=0.68). There were more surgeries preformed (across all surgery types) amongst female patients with a cumulative incidence of 29.4% at 10 years compared to 23.5% for men during the same time period (p=0.057).
The rates of arthritis related surgery continue to decrease for patients more recently diagnosed with RA, especially soft tissue procedures and knee surgeries. This trend is particularly noticeable in women. This decrease in rates may reflect improved treatments or secular trends in disease expression or changes in practice patterns.
To cite this abstract, please use the following information:
Shourt, Courtney A., Crowson, Cynthia S., Gabriel, Sherine E., Matteson, Eric L.; Trends in Orthopedic Surgery Utilization among Patients with Rheumatoid Arthritis: A Focus on Surgery Type and Gender. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1570