Breaking News
December 19, 2018 - FDA Approves Genentech’s Tecentriq in Combination With Avastin and Chemotherapy for the Initial Treatment of Metastatic Non-Squamous Non-Small Cell Lung Cancer
December 19, 2018 - Mediterranean Diet for Osteoarthritis | About OA
December 19, 2018 - Successful bladder repair using silk fibroid scaffolds
December 19, 2018 - Quidel receives CE mark to use Sofia 2 Lyme+ Fluorescent Immunoassay with Sofia 2 analyzer
December 19, 2018 - Horizon Discovery partners with C4XD to validate novel synthetic lethal oncology targets
December 19, 2018 - Research suggests a promising therapeutic target to treat or prevent metabolic disorders
December 19, 2018 - Split liver transplants could save children on wait list finds study
December 19, 2018 - Michigan-based food manufacturer ordered to discontinue operations after recurrent food safety violations
December 19, 2018 - Incorrect prescribing warnings in electronic prescribing systems
December 19, 2018 - New $1.6 million NIH grant supports study on a gene vital to circadian rhythms
December 19, 2018 - Racial Disparities Seen Among Teens Undergoing Flu Vaccination
December 19, 2018 - To resolve inflammation, location matters
December 19, 2018 - Dancing could help older women to perform their daily tasks
December 19, 2018 - Research identifies new therapeutic target for cancer treatment and tissue regeneration
December 19, 2018 - Energy costs, social isolation contribute to health risk of older adults in extreme weather
December 19, 2018 - Potential combination therapy against rare disease of the bone marrow could improve treatment
December 19, 2018 - Researchers aim to improve cognition, reverse weight gain in schizophrenia
December 19, 2018 - UC San Diego Health offers new DRG stimulation device for phantom limb pain
December 19, 2018 - Study examines relationship between growth restriction and risk of childhood mortality
December 19, 2018 - New study provides insights on increased risk of suicide in young patients visiting ED
December 19, 2018 - AHA: Thyroid Problems Linked to Worsening Heart Failure
December 19, 2018 - World-first coeliac disease vaccine enters Phase 2 trials
December 19, 2018 - RNA sequencing offers novel insights into the microbiome
December 19, 2018 - A promising, effective vaccine for common respiratory disease
December 19, 2018 - Protein may slow progression of emphysema, study finds
December 19, 2018 - Studying atrial fibrillation — and exploring new frontiers in precision health
December 19, 2018 - A New Way To Get College Students Through A Psychiatric Crisis — And Back To School
December 19, 2018 - Optum, UnitedHealthcare take action to help people affected by North Carolina winter storms
December 18, 2018 - Weight change in middle-aged, elderly Chinese Singaporeans related to increased risk of death
December 18, 2018 - Immune cells sacrifice themselves to protect us from invading bacteria
December 18, 2018 - Watching brain cells fire, with a twist of gravitational waves
December 18, 2018 - 2018 in Review
December 18, 2018 - Getting the Most Out of the CLARITY Technique
December 18, 2018 - NVF shoes provide a viable option for track and road racing
December 18, 2018 - CRISPR may restore effectiveness of chemotherapies used to treat lung cancer
December 18, 2018 - New app accurately measures and charts progression of skin wounds
December 18, 2018 - Persistent Discrimination ID’d Among Physician Mothers
December 18, 2018 - Cellphone technology developed to detect HIV
December 18, 2018 - A Stanford doctor hits the field with the 49ers — as their airway management physician
December 18, 2018 - The Rise of Anxiety Baking
December 18, 2018 - Just one night of sleep deprivation increases the urge to eat
December 18, 2018 - Study reveals mechanism behind failed remyelination in MS
December 18, 2018 - New genetic testing method increases the precision of biomarker analysis
December 18, 2018 - Simple technique to effectively treat underdiagnosed cause of debilitating chest pain
December 18, 2018 - Barbershop-based medical intervention can successfully lower blood pressure, new data shows
December 18, 2018 - Food labels have caused changes in consumers’ intake and industry’s use of key additives
December 18, 2018 - Sickest children could benefit from split liver transplants
December 18, 2018 - Scientists create patient-specific model to identify most effective treatment for appendix cancer
December 18, 2018 - ‘Little Foot’ endocast reveals a small brain combining ape-like and human-like features
December 18, 2018 - New therapy for childhood blindness shows ‘very promising’ results
December 18, 2018 - Researchers discover promising new compound against Buruli ulcer
December 18, 2018 - Study finds significant use of traditional, complementary and alternative medicines in Sub-Saharan Africa
December 18, 2018 - California Farm Implicated in Outbreak of E. coli Tied to Romaine Lettuce
December 18, 2018 - Mobile health has power to transform HIV/AIDS nursing
December 18, 2018 - Celiac Vaccine in Clinical Trials at Columbia
December 18, 2018 - Research into mental health first aid prompts practical guidance and resources for workplace
December 18, 2018 - Researcher conducts study to investigate peripheral blood markers of Alzheimer’s disease
December 18, 2018 - Researchers identify link between mucus in the small airways and pulmonary fibrosis
December 18, 2018 - EU Commission’s Health Policy Platform to host EKHA program on transplantation
December 18, 2018 - Survivors of childhood Hodgkin lymphoma have high risk of developing solid tumors
December 18, 2018 - Small changes to cafeteria design can get kids to eat healthier, new assessment tool finds
December 18, 2018 - From Machines to Cyclic Compounds
December 18, 2018 - New study reveals best assessment tools to establish delirium severity
December 18, 2018 - Rice University scientists develop synthetic protein switches to control electron flow
December 18, 2018 - Home-based pulmonary function monitoring for teens with Duchenne muscular dystrophy
December 18, 2018 - Researchers identify potential target for new breast cancer treatments
December 18, 2018 - National Biofilms Innovation Centre award grant to Neem Biotech for novel anti-biofilm drug development
December 18, 2018 - Artificial intelligence and the future of medicine
December 18, 2018 - Montana State doctoral student receives grant for her work to improve neuroscience tool
December 18, 2018 - Early postpartum initiation of opioids associated with persistent use
December 18, 2018 - Russian scientists identify molecular ‘switch’ that could be target for treatment of allergic asthma
December 18, 2018 - Surgeons make more mistakes in the operating room during stressful moments, shows study
December 18, 2018 - Immune cells explode themselves to inform about the danger of invading bacteria
December 18, 2018 - Malnutrition in children with Crohn’s disease linked with increased risk of surgical complications
December 18, 2018 - FDA Approves Motegrity (prucalopride) for Adults with Chronic Idiopathic Constipation (CIC)
December 18, 2018 - The long and short of CDK12
December 18, 2018 - Hologic’s Cynosure division introduces TempSure Surgical RF technology in North America
December 18, 2018 - CMR Surgical partners with Nicholson Center to launch U.S.-based training program for Versius
December 18, 2018 - Findings reinforce guidelines for cautious use of antipsychotics in younger populations
December 18, 2018 - Study finds new strains of hepatitis C virus in sub-Saharan Africa
Frequency of joint replacements halved in rheumatoid arthritis patients between 1997-2010

Frequency of joint replacements halved in rheumatoid arthritis patients between 1997-2010

image_pdfDownload PDFimage_print

The results of two studies presented today at the Annual European Congress of Rheumatology (EULAR 2018) investigate joint replacement procedures in rheumatoid arthritis (RA) patients. The first study demonstrates that joint replacement procedures have significantly reduced in RA patients in the past decade and the second investigates the impact of biologic therapies on this change using the British Society for Rheumatology Biologics Registry for Rheumatoid Arthritis (BSRBR/RA).

“We welcome these results demonstrating such a dramatic reduction of joint replacements in RA patients in recent years,” said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. “It’s also very interesting to see data relating specifically to the impact of biological treatments on this outcome given the breadth of progress in the management of RA over the same time period.”

Joint replacement surgery halved in rheumatoid arthritis patients between 1997-20101

The retrospective cohort study examined data from around one million people between 1997 and 2010 using administrative healthcare data. Results demonstrate a striking reduction of 51.9% (pjoint replacement surgery in RA patients between 1997 and 2010.

The number of joint replacements in matched controls increased by 31.9% (p=0.002) over the 13 years, although remained significantly less than in RA patients at both time points (4.78% vs. 0.47% in 1997 and 2.30% vs. 0.62% in 2010). Rates of cardiac interventions did not change significantly over time in either group suggesting the changes observed in joint replacement surgery were due to improvements in the treatment of RA rather than access to surgical procedures.

“Literature to date has reported inconsistent findings,” said Dr. John Hanly, Professor of Medicine (Rheumatology) and Pathology at Dalhousie University and attending staff rheumatologist at the Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada. “However, our results add significant evidence to show a clear reduction in joint replacement surgery in RA patients, most likely due to improvements in medical management over the last few decades.”

Cases of RA were identified using a method previously validated in the same data set.3 Each case was matched by age and gender to four randomly selected controls. The number of RA cases increased from 3,913 (0.42%) to 4,911 (0.52%) over the study, the mean age changed from 56.7 to 60.1 years and the proportion of females from 70.8 to 73.9%. Annual frequency of joint replacement surgery as well as coronary artery interventions was compared.

Impact of biological therapy on rate of joint replacement procedures

The management of RA has progressed significantly over the last 25 years from providing relief of symptoms to regimens that impact disease activity. This evolution has been multi-factorial, however it is widely recognised that the introduction of biological therapy with tumour necrosis factor inhibitors (TNFi) in the late 1990s revolutionised treatment Furthermore, recent research from the UK and Denmark has demonstrated a decline in the incidence of joint replacements for RA patients directly following the introduction of TNFi. However, findings presented today suggest that, although TNFi use may reduce the need for total hip replacement (THR) in older and more severe RA patients, no association was found in younger or less severe patients. Neither was there an association in rates of total knee replacement (TKR) or other joint replacement.

“The use of biologic therapies has been routinely offered as an explanatory factor for the reduction in rates of joint replacement over recent years,” said Mr Samuel Hawley, University of Oxford. “Our study offers some support for this in that a reduction in hip replacement procedures was observed in older patients on TNFi, although our results also suggest additional factors are likely to be involved. For example, the drive for earlier diagnosis/treatment and increased prescription rates of conventional synthetic disease-modifying antirheumatic drugs. It’s important to highlight that we used an observational study design and that despite our best efforts to address confounding factors, these may still partly explain our findings.”

The study analysed the differences between RA patients who were TNFi or conventional synthetic disease-modifying antirheumatic drug (csDMARD) users in a 1:1 propensity score matched cohort of 19,116 patient records using the BSRBR/RA data. In the full study population, investigators found no significant association between TNFi use and THR or TKR. However, there was a significant reduction of THR by 40% in those over 60 years taking TNFi (HR 0.60 [CI:0.41-0.87]) and THR rate was cut by a quarter in TNFi users when analyses were restricted to more severe patients (DAS>5.1), although this didn’t reach significance (HR 0.74 [CI 0.51-1.05]). No significant findings were found relating TNFi users with TKR procedures.


Explore further:
Patients with rheumatoid arthritis have an increased risk of certain types of malignancy

Provided by:
European League Against Rheumatism (EULAR)

Tagged with:

About author

Related Articles