Trends in Total Joint Arthroplasty Among Patients With Rheumatoid Arthritis: The Effect of Recent Disease Modifying Antirheumatic Drug Utilization Guidelines.

Autor:	Hodo TW; From the Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA (Dr. Hodo, Dr. Wilder, Dr. Cole, Dr. Savoie, and Dr. Sherman), and the Department of Orthopaedic Surgery, Emory University School of Medicine, Druid Hills, GA (Dr. Ross)., Wilder JH, Ross BJ, Cole MW, Savoie FH 3rd, Sherman WF
Jazyk:	angličtina
Zdroj:	Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews [J Am Acad Orthop Surg Glob Res Rev] 2022 Dec 05; Vol. 6 (12). Date of Electronic Publication: 2022 Dec 05 (Print Publication: 2022).
DOI:	10.5435/JAAOSGlobal-D-22-00209
Abstrakt:	Introduction: The 2015 change in the American College of Rheumatology (ACR) guidelines narrowed indications for initiating treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). This study sought to evaluate trends in total joint arthroplasty (TJA) in patients with RA and to characterize the effect of bDMARDs on arthroplasty risk in this population after the change in ACR treatment guidelines. Methods: A retrospective review was conducted using the PearlDiver database. TJA procedures included total shoulder arthroplasty, total elbow arthroplasty, total hip arthroplasty, and total knee arthroplasty. The Cochran-Armitage Trend Test was used to evaluate trends in the volume of TJA procedures conducted in patients with RA between 2010 and 2019. Logistic regression was used to compare 2-year arthroplasty risk after an initial joint-specific RA International Classification of Diseases 10th Revision diagnosis for RA patients with versus without bDMARD exposure. Results: A total of 2,942,360 patients with RA were identified, and 80,744 (2.74%) underwent TJA between 2010 and 2019. Rates of TJA procedures trended significantly upward over the decade (2.6% versus 5.1%, P < 0.001) with a sharp increase between 2015 and 2016 (2.1% versus 4.9%, P < 0.001). Among the 16,736 identified patients with an initial International Classification of Diseases 10th Revision joint-specific RA diagnosis, 3362 patients (20.09%) were treated with bDMARDs and 13,374 (79.91%) were not. Untreated patients exhibited significantly lower risk of any TJA (5.92% versus 7.73%; odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.64 to 0.82), total hip arthroplasty (OR: 0.69, 95% CI: 0.50 to 0.95), and total knee arthroplasty (OR: 0.63, 95% CI: 0.52 to 0.75) compared with treated patients. Discussion: The volume of TJA procedures conducted in patients with RA has trended markedly upward over the past decade, with a sharp increase after 2015. bDMARD treatment was associated with markedly increased risk of TJA, likely because of initiation of bDMARDs in only those patients with advanced disease per ACR guidelines. (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)
Databáze:	MEDLINE
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