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Trends in Joint Replacement Surgery in Patients with Rheumatoid Arthritis

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Young BL1, Watson SL1, Perez JL1, McGwin G1, Singh JA1, Ponce BA1. J Rheumatol. 2017 Dec 1. pii: jrheum.170001. doi: 10.3899/jrheum.170001. [Epub ahead of print]

Abstract

1 From the University of Alabama at Birmingham (UAB) divisions of Orthopaedic Surgery, and Clinical Immunology and Rheumatology, and the Department of Epidemiology, Birmingham, Alabama; and the Carolinas Medical Center Department of Orthopaedic Surgery, Charlotte, North Carolina, USA. B.L. Young, MD, Resident, Carolinas Medical Center Department of Orthopaedic Surgery; S.L. Watson, BA, Research Fellow, UAB Division of Orthopaedic Surgery; J.L. Perez, MD, Research Fellow, UAB Division of Orthopaedic Surgery; G. McGwin, MS, PhD, Professor and Vice Chairman, UAB Department of Epidemiology; J.A. Singh, MBBS, MPH, Professor, UAB Division of Clinical Immunology and Rheumatology; B.A. Ponce, MD, Associate Professor, UAB Division of Orthopaedic Surgery. Address correspondence to Dr. B.A. Ponce, 1313 13th St. South, Birmingham, Alabama 35205-5327, USA. E-mail: bponce@uabmc.edu. Accepted for publication September 12, 2017.

Abstract

OBJECTIVE: This study analyzed trends in large total joint arthroplasties (TJA) and in the proportion of these procedures performed on patients with rheumatoid arthritis (RA).

METHODS: The US Nationwide Inpatient Sample (2002-2012) was used to identify the incidences of total shoulder (TSA), elbow (TEA), knee (TKA), hip (THA), and ankle (TAA) arthroplasty and the proportion of these performed with coexisting RA.

RESULTS: The prevalence of RA among patients with TJA increased 3.0%. The prevalence of RA among cases of TEA and TSA decreased by 50% (p < 0.0001) and 18% (p = 0.0016), respectively; a 38.0% decrease occurred in the prevalence of RA among TAA (p = 0.06); and nonsignificant increases were seen among THA and TKA. The average age difference between RA and non-RA patients undergoing TJA narrowed by 2 years (p < 0.0001). There was a greater reduction in the proportion of TSA, TEA, and TAA groups among women with RA than men with RA. In the TSA and TEA groups, there was a reduction in the proportion of whites with RA, but not blacks. The proportion of privately insured TSA and TAA patients with RA decreased, while patients with RA undergoing TSA, TEA, or TAA who were receiving Medicaid (government medical insurance) remained relatively stable over time.

CONCLUSION: The prevalence of RA has decreased among TSA and TEA patients. A nonsignificant decline occurred among TAA patients. The average age of TJA patients with RA is beginning to mirror those without RA. Sex ratios for TSA, TEA, and TAA patients are following a similar pattern. These results may be evidence of the success of modern RA treatment strategies.