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. 2013 Aug;84(4):331-7.
doi: 10.3109/17453674.2013.810519. Epub 2013 Jun 25.

The decline in joint replacement surgery in rheumatoid arthritis is associated with a concomitant increase in the intensity of anti-rheumatic therapy: a nationwide register-based study from 1995 through 2010

Esa Jämsen  1 , Lauri J Virta, Markku Hakala, Markku J Kauppi, Antti Malmivaara, Matti U K Lehto
Affiliations

The decline in joint replacement surgery in rheumatoid arthritis is associated with a concomitant increase in the intensity of anti-rheumatic therapy: a nationwide register-based study from 1995 through 2010

Esa Jämsen et al. Acta Orthop. 2013 Aug.

Abstract

Background and purpose: Drug-based treatment of rheumatoid arthritis (RA) has evolved markedly over the past 2 decades. Using nationwide register data, we studied how this has affected the rates of hip, knee, shoulder, and elbow replacement from 1995 to 2010.

Methods: The number of primary joint replacements was obtained from the Finnish Arthroplasty Register. To test the hypothesis that improvements in medical treatment of RA reduce the need for joint replacements, we also collected data about purchases of different disease-modifying anti-rheumatic agents (DMARDs) and biological drugs from the nationwide drug registers.

Results: The annual incidence of primary joint replacements for RA declined from 19 per 10(5) in 1995 to 11 per 10(5) in 2010. The decline was greater for upper-limb operations than for lower-limb operations. At the same time, the numbers of individuals using methotrexate, hydroxychloroquine, and sulfasalazine (the most commonly used DMARDs) increased 2- to 4-fold.

Interpretation: Our results are in accordance with observations from other countries, and indicate that the use of joint replacements in RA has decreased dramatically. Our data suggest that effective medical therapy is the most likely explanation for this favorable development.

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Figures

Figure 1.
Figure 1.
Annual absolute numbers of primary hip and knee replacements (left) and shoulder and elbow replacements (right) performed for RA and other diagnoses (including osteoarthritis, other arthritides, trauma, and developmental hip dysplasia) from 1995 through 2010.
Figure 2.
Figure 2.
Annual incidence of hip, knee, shoulder, and elbow replacements for RA (A), proportion of joint replacements for RA (of all joint replacements performed annually) (B), and use of different DMARDs (C) from 1995 through 2010 according to data from Finnish health registers. Panel D shows a strong inverse relationship between the total annual incidence of joint replacements for RA and the use of methotrexate.
See this image and copyright information in PMC

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