Abstract
Objectives. To assess the nature, incidence and secular change of orthopaedic intervention since 1986 in two inception cohorts of early RA patients with maximum follow-up of 25 years.
Methods. The study examines data from the Early RA Study (1986-1999, 9 centres, n=1465) and the Early RA Network (2002-date, 23 centres, n=1236) together with linkage to national datasets (Hospital Episode Statistics, National Joint Registry and Office of National Statistics). Clinical, laboratory and x-ray measures were standardised and performed yearly in both cohorts. Disease modifying, steroid and biologic therapies reflected conventional practice and guidelines of the time frames examined. Recruitment years were grouped into 6 periods and interventions classified into major, intermediate and minor categories.
Results. A total of 1602 procedures were performed in 770 patients (29%) over maximum 25 year follow-up. The 25 year cumulative incidence rate of major interventions was 21.7% (19.4–24.0%), and 21.5% (17.8–25.5%) for intermediate. There were declines in the cumulative incidence of intermediate-type surgeries on moving from earlier to more recent recruitment periods (p<0.001), but not for major/minor surgery. These declines coincided with a gradual shift from sequential monotherapy to combination DMARD therapies and biologics in later recruitment periods.
Conclusions: Orthopaedic surgery is an important and common outcome in RA. Only hand/foot surgery rates showed a consistent decline from 1986-2011. Possible explanations include differences in pathophysiological processes affecting joints; variations in responses to therapy between large and small joint destructive processes; changes in service provision and thresholds for surgery over time.
Methods. The study examines data from the Early RA Study (1986-1999, 9 centres, n=1465) and the Early RA Network (2002-date, 23 centres, n=1236) together with linkage to national datasets (Hospital Episode Statistics, National Joint Registry and Office of National Statistics). Clinical, laboratory and x-ray measures were standardised and performed yearly in both cohorts. Disease modifying, steroid and biologic therapies reflected conventional practice and guidelines of the time frames examined. Recruitment years were grouped into 6 periods and interventions classified into major, intermediate and minor categories.
Results. A total of 1602 procedures were performed in 770 patients (29%) over maximum 25 year follow-up. The 25 year cumulative incidence rate of major interventions was 21.7% (19.4–24.0%), and 21.5% (17.8–25.5%) for intermediate. There were declines in the cumulative incidence of intermediate-type surgeries on moving from earlier to more recent recruitment periods (p<0.001), but not for major/minor surgery. These declines coincided with a gradual shift from sequential monotherapy to combination DMARD therapies and biologics in later recruitment periods.
Conclusions: Orthopaedic surgery is an important and common outcome in RA. Only hand/foot surgery rates showed a consistent decline from 1986-2011. Possible explanations include differences in pathophysiological processes affecting joints; variations in responses to therapy between large and small joint destructive processes; changes in service provision and thresholds for surgery over time.
| Original language | English |
|---|---|
| Journal | Annals of the Rheumatic Diseases |
| Publication status | In preparation - 2014 |