Hospitalization for musculoskeletal disorders in rheumatoid arthritis patients: a population-based study.

Marina Amaral De Ávila Machado,Louis Bessette,Elham Rahme,Sasha Bernatsky,Hacene Nedjar

doi:10.1186/s12891-016-1142-4

Abstract

BackgroundRheumatoid arthritis (RA) patients failing disease modifying antirheumatic drugs (DMARDs) may undergo anti-Tumor Necrosis Factor (anti-TNF) therapy. Using the Quebec health services administrative databases, we examined the rates of musculoskeletal (MSD)-related hospitalizations among RA patients receiving anti-TNF, DMARDs, and neither of those therapies (non-users).MethodsMatched cohort analyses were performed separately in 2002–2006 and 2007–2011. In each cohort, DMARD and non-user groups were formed to 3-1 match the anti-TNF users on age, sex, date of RA diagnosis, high-dimensional propensity score and date of the first anti-TNF dispensation (index-date). Non-users did not use DMARDs or anti-TNF drugs during the year before the index-date and in the 90 days post, but used at least one of these medications in the study period.ResultsDuring 2002–2006, 557 anti-TNF users were matched to 1144 DMARD users and to 656 non-users, compared to 690, 1651, and 532 patients, respectively during 2007–2011. The crude rates of MSD-related hospitalizations in the anti-TNF, DMARD and non-users groups were respectively: 8.2/100, 6.4/100 and 10.5/100 patient-years in 2002–2006, and 6.9/100, 4.8/100, and 8.6/100 patient-years in 2007–2011. In multivariable Cox regression models, the hazard ratios of MSD-related hospitalizations (95 % confidence interval) were: 0.95 (0.60; 1.50) for anti-TNF and 0.69 (0.46; 1.02) for DMARD users, versus non-users in 2002–06, and 0.65 (0.37; 1.14) and 0.40 (0.24; 0.66), respectively in 2007–2011.ConclusionThe MSD-related hospitalization risk was lower in RA patients using DMARD therapy and similar in those using anti-TNF therapy with or without DMARDs as compared to those not using either of these therapies during the study period.

Highlights

Rheumatoid arthritis (RA) patients failing disease modifying antirheumatic drugs (DMARDs) may undergo anti-Tumor Necrosis Factor therapy
Patient baseline characteristics Matching by high-dimensional propensity score, age and sex, removed most differences in baseline patient characteristics between the treatment groups except those related directly to the treatment choice such as prior corticosteroid and Régie de l’assurance maladie du Québec (NSAIDs) use, prior visits to rheumatologists and socioeconomic status (Table 2)
In 2002–2006, patients in the anti-Tumor Necrosis Factor (TNF) group and those in the DMARD group had higher socioeconomic status (SES) compared to non-users and were more likely than non-users to have taken corticosteroids and

Summary

Introduction

Rheumatoid arthritis (RA) patients failing disease modifying antirheumatic drugs (DMARDs) may undergo anti-Tumor Necrosis Factor (anti-TNF) therapy. Using the Quebec health services administrative databases, we examined the rates of musculoskeletal (MSD)-related hospitalizations among RA patients receiving anti-TNF, DMARDs, and neither of those therapies (non-users). Combination therapy with DMARDs (methotrexate +/−hydroxychloroquine +/− sulfasalazine) and/or the addition of biologic agents that target Tumor Necrosis Factor (TNF) is considered in patients who have an. Randomized controlled trials (RCT) and observational studies have demonstrated benefits of anti-TNF agents in RA treatment on the basis of both disease activity and joint damage [6, 7]. Some observational studies have considered hospital admissions as an effectiveness indicator showing that anti-TNF therapy may reduce the rate of hospitalization, the results remain uncertain [8, 9]

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Discussion

Conclusion