bDMARDs, RA Guidelines and Their Effect on THR, TKR
What happens to rheumatoid arthritis (RA) rates when biological DMARDs (disease-modifying anti-rheumatic drugs) are introduced into a population?
Using a large registry, Danish researchers set out to answer this question.
Their work, “Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time-series analysis using nationwide Danish healthcare registers,” appears in the December 15, 2017 edition of Annals of the Rheumatic Diseases.
René Lindholm Cordtz, Ph.D. student at the Center for Rheumatology and Spine Diseases, Rigshospitalet-Gentofte in Copenhagen, Denmark and co-author on the study, told OTW, “We thought the topic was interesting because biological DMARDs [bDMARDS] have proven effective in minimizing disease activity among rheumatoid arthritis patients, but it is unsure if they affect the risk of major joint surgery, more specially the need for total hip and total knee joint replacements.”
“These surgical interventions are considered surrogate markers of end-stage joint damage in rheumatoid arthritis patients.”
“The main advantage of our study design was the use of nationwide healthcare registers in Denmark, a nation with universal healthcare access for all residents.”
“We were able to show the secular trends in a cohort of rheumatoid arthritis (RA) patients and to compare with age, sex and municipality matched general population controls. The use of interrupted time series analysis allowed us to visualize changes in incidence rates before and after introduction of biological DMARDs, and not just the overall incidence rate before and after.”
“The major finding was that the 5-year incidence rate of total knee replacements increased among rheumatoid arthritis patients and general population controls, but following the introduction of biological DMARDs in 2003, the incidence rate started to decrease for rheumatoid arthritis patients, whereas it continued to increase in the general population.”
“The incidence rate of total hip replacements had already started to decrease among rheumatoid arthritis patients before biological DMARDs were available suggesting that other factors such as increased focus on early aggressive treatment with conventional DMARDs could have affected this joint, but this remains speculation.”
“Our results indicate that modern treatment of RA has a direction of great benefit for these patients as their risk of major joint destruction and the need for joint replacement are approaching the level in the general population.”
“The short-term risk of joint failure and associated risk of total hip and knee replacement has decreased for rheumatoid arthritis patients, and looks to be getting closer to the incidence rate among age- and sex matched individuals from the general population.”
