Abstract
BackgroundThis study evaluated the effect of early anti-tumor necrosis factor (TNF) therapy in patients with severe rheumatoid arthritis (RA) on the subsequent risk of total knee replacement (TKR) surgery.MethodsThis retrospective observational study included a hospital-based cohort of 200 patients diagnosed with severe RA who received treatment with anti-TNF therapy between 2003 and 2014. Clinical parameters including age, sex, body mass index, and the time from the diagnosis of RA to the initiation of anti-TNF therapy were analyzed.ResultsOf the 200 enrolled patients, 84 underwent an early intervention (≤3 years from the diagnosis of RA to the initiation of anti-TNF therapy), and 116 underwent a late intervention(>3 years from the diagnosis of RA to the initiation of anti-TNF therapy). Five (6.0%) patients in the early intervention group underwent TKR compared to 31 (26.7%) in the late intervention group (p = 0.023). After adjusting for confounding factors, the late intervention group still had a significantly higher risk of TKR (p = 0.004; odds ratio, 5.572; 95% confidence interval, 1.933–16.062). Those receiving treatment including methotrexate had a lower risk of TKR (p = 0.004; odds ratio, 0.287; 95% confidence interval, 0.122–0.672).ConclusionsDelayed initiation of anti-TNF therapy in the treatment of severe RA was associated with an increased risk of TKR surgery. Adding methotrexate treatment decreased the risk of future TKR.
Highlights
This study evaluated the effect of early anti-tumor necrosis factor (TNF) therapy in patients with severe rheumatoid arthritis (RA) on the subsequent risk of total knee replacement (TKR) surgery
The purpose of this study was to examine the effect of a delayed initiation of anti-TNF therapy in patients diagnosed with severe RA on the subsequent risk of TKR surgery
The inclusion criteria were: 1) a diagnosis of RA based on the 1987 American College of Rheumatology criteria [20]; 2) severe RA before anti-TNF treatment for more than 6 months; and 3) taking at least two disease-modifying anti-rheumatic drugs (DMARDs) for more than 2 years
Summary
This study evaluated the effect of early anti-tumor necrosis factor (TNF) therapy in patients with severe rheumatoid arthritis (RA) on the subsequent risk of total knee replacement (TKR) surgery. The knee is a major weight-bearing joint in which patients with severe RA may experience bone destruction and disability [2,3,4,5], and some will require total knee replacement (TKR). One 18-year longitudinal study published in 1998 estimated that 25% of all patients with RA required total joint replacement surgery [10]. The incidence of joint replacement surgery in patients with RA has decreased in recent years, primarily because of the development of more effective medical treatment [11,12,13]. The general increasing trend in the use of synthetic and biological disease-modifying anti-rheumatic drugs (DMARDs) has reduced the incidence of joint destruction and improved the long-term prognosis of patients with RA [14]
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