Joint Surgery Decline for RA Patients

Rheumatoid arthritis patients need for orthopedic surgery down over time in new Swedish study

(RxWiki News) Given the choice, many people might rather pop a pill than go under the knife for surgery. And based on new research from Sweden, it seems that more and more rheumatoid arthritis patients may not need surgery due to modern medication.

In this new study, researchers wanted to explore trends in joint surgery and try to understand if the increasing use of medications for rheumatoid arthritis was helping to reduce the need for surgery.

The researchers found that among a population of Swedish rheumatoid arthritis patients, the incidence of orthopedic surgery dropped between 1998 and 2011.

"Ask your doctor about low-impact exercise options if joint pain is a problem."

Rheumatoid arthritis (RA) is a chronic condition that causes inflammation, pain and swelling in the joints, often in the hands and feet. While there is no cure for RA, treatments include medication and in some cases, orthopedic surgery to repair damaged joints.

Though orthopedic surgery is an effective option for many patients with severe RA, "the aim of modern pharmacologic treatment is to prevent joint destruction and reduce the need for orthopedic surgery," according to Korosh Hekmat, MD, specialist in internal medicine rheumatology of Malmö University in Malmö, Sweden, and colleagues.

To explore if modern medicine was succeeding in the goal of reducing surgeries, Dr. Hekmat and colleagues relied on RA patient registries in Sweden to identify patients and data from the national population register and the regional healthcare register for information on population, numbers of surgeries and medication use.

The researchers identified 2,342 patients with an RA diagnosis, 68.7 percent of whom were women.

The participants were sent health assessment questionnaires in 1997, 2002, 2005 and 2009. The average response rates were between 62 percent and 74 percent.

Dr. Hekmat and team estimated the annual rate of orthopedic surgeries and compared the years 1998 to 2001, 2002 to 2006 and 2007 to 2011.

The researchers found that during the whole study period, from 1998 to 2011, the estimated orthopedic surgery incidence was 82.3 out of 1,000 person-years (the number of years multiplied by the number of people affected by RA). However, the rate seemed to decline over time.

The estimated orthopedic surgery incidence was 94.6 out of 1,000 during 1998 to 2001, 82.6 out of 1,000 during 2002 to 2006 and 71.8 out of 1,000 during 2007 to 2011.

Dr. Hekmat and colleagues also found that hip surgery declined over time, but the same was not true of knee surgery.

"The overall incidence of orthopedic surgery declined over time which coincides with increasing use of more intensive pharmacological treatment including the use of biologics," the researchers wrote.

"Improved management may reduce the need for orthopedic interventions in patients with RA," they wrote.

"Before the medications (DMARDS) were introduced, a hand surgeon's office would have been filled with rheumatoid patients," said Jonathan Sorelle, MD, Medical Director of the Minimally Invasive Hand Institute in Las Vegas, NV.

I make a diagnosis of rheumatoid arthritis often, but less and less frequently do I have to operate because the medications stave off fractures that can be a result of the disease," Dr. Sorelle told dailyRx News.

"I do believe though that there are still a number of RA patients who benefit from surgery. Some RA patients may require joint replacement or tendon transfer. In addition, there are more insidious effects of rheumatoid arthritis, including swelling within the carpal tunnel that can cause carpal tunnel syndrome, which may need to be treated surgically," said Dr. Sorelle, who was not involved in this study.

"Overall I am very pleased with the progress of our medical colleagues and with our pharmaceutical advancements," he said.

It is important to note that while the researchers saw an increasing use of pharmacological treatment overall during this time, they did not confirm that individual patients who avoided surgery were using these medications. Further research is needed to confirm these findings.

This study will be presented October 29 at the American College of Rheumatology Annual Meeting in San Diego. Studies presented at conferences are considered preliminary until published in a peer-reviewed journal.

No conflicts of interest were reported by the authors.

Review Date: 
October 22, 2013