Abstract
Objective: To determine the trend of incidence rate of total knee arthroplasty (TKA), total hip arthroplasty (THA), and TKA or THA (major joint arthroplasty, MJA) among rheumatoid arthritis (RA) population and compared them with general population (GP) in Taiwan.Methods: Incidence rates and trends of TKA, THA, and MJA were determined over a 14-year period (2000–2013) among RA patients and compared them with GP. RA of patients was diagnosed based on the ACR 1987 criteria and extracted from GP. Subanalyses of incidences of TKA, THA, and MJA by year, 10-year age group, and gender were further conducted for demographic analysis. Patient profiles were extracted from the National Health Insurance Research Database (NHIRD) for interrupted time-series analysis and cohort studies.Results: Patients enrolled were 168,457 receiving TKA, 64,543 receiving THA, and 228,191 receiving MJA surgery. Incidences of TKA, THA, and MJA in RA patients were significantly lower by 49.0, 41.5, and 41.0% compared with concomitantly rises in GP by 131.0, 25.1, and 90.0% among the GP during the study period. The dominant age population for TKA, THA, and MJA were those aged 70–79 years in both GP and RA groups.Conclusions: We found an opposing trend in incidence of TKA, THA, and MJA between RA patients and the GP. The possible influence of pharmacological treatment is implicated for the lower incidence rates of TKA, THA, and MJA surgeries among RA patients.
Highlights
Rheumatoid arthritis (RA) is one of the most prevalent chronic inflammatory diseases causing structural changes such as major joint deformity and soft tissue damage [1]
The National Health Insurance Research Database (NHIRD) data base comprised of 29,610,129 registered patients (GP cohort), including 35,219 RA patients
Among the general population (GP), comparing within years from 2000 to 2013, we found significant increments in their number of surgery and incidence rate (p for trend < 0.001): for total knee arthroplasty (TKA) (N = 7,068–17,432 with incidence rate from 31.70 to 73.30 per 100,000 person years), total hip arthroplasty (THA) (N = 4,160–5,583 with incidence rate from 16.64 to 23.39 per 100,000 person years), and major joint arthroplasty (MJA) (N = 11,075–22,438 with incidence rate from 49.70 to 94.56 per 100,000 person years) (Figure 2)
Summary
Rheumatoid arthritis (RA) is one of the most prevalent chronic inflammatory diseases causing structural changes such as major joint deformity and soft tissue damage [1]. Medications for RA are to improve function and prevent persistent major joint destructions. Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs), applied as monotherapy or in combination with other anti-inflammatory drugs, had showed promising efficacy in preventing RA from progressing to late stages and improving functional outcome during since late 1980s [4]. Despite the effectiveness of pharmacological treatment, orthopedic procedures remain indispensable in managing severe RA. Among these procedures, total joint arthroplasty is the only available solution for non-reversible joint destruction of these patients. RA patients in Taiwan suffer 4.02 times greater risk, compared with non-RA patients, of undergoing major joint arthroplasty (MJA) surgeries, including total knee arthroplasty (TKA) and total hip arthroplasty (THA) [6]. Up to 24% of patients with RA underwent MJA with substantial improvements of overall function and quality of life [7, 8]
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