Patient Reported Outcomes and Orthopedic Surgery in Rheumatoid Arthritis

Abstract: Orthopedic surgery is used effectively in many patients with severe rheumatoid arthritis RA). The aim of modern pharmacologic treatment is to prevent joint destruction and reduce the need for orthopedic surgery. Patient reported outcomes (PROs) are important measures of the burden of RA. A large, community based RA cohort, established in 1997, was investigated. Patients were classified according to the 1987 American College of Rheumatology criteria for RA. PROs were assessed in four questionnaire surveys performed in 1997, 2002, 2005 and 2009. The incidence of major joint arthroplasty and orthopedic surgery overall was estimated based on linkage to the Swedish National Knee and Hip Arthroplasty registers and a regional patient administrative database. There was a significant decrease in total hip arthroplasty in patients with RA after 2001, and a decline in orthopedic surgery in general, with the exception of knee surgery. PROs were improved in later surveys, parallel to more extensive treatment. Despite similar treatment, male patients reported better outcomes and more improvement, in particular regarding pain, compared to female patients. Rheumatoid factor positivity, female sex and severe PROs predicted orthopedic surgery. Biologic disease modifying anti-rheumatic drug (bDMARD) treatment was associated with increased rate of orthopedic surgery overall. This most likely reflects confounding by indication in patients with severe, refractory RA. This pattern was not seen in early disease, where the benefits of bDMARDs on joint damage may be greater. bDMARD treatment may have a different effect on disease progression in hip joints compared to knees and feet.