Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN 55905, USA.
J Rheumatol. 2012 Mar;39(3):481-5. doi: 10.3899/jrheum.111056. Epub 2012 Jan 15.
To describe current trends in arthritis-related joint surgery among a population-based cohort of patients with rheumatoid arthritis (RA) and to examine the influence of joint surgery on mortality.
A retrospective medical record review was performed of all orthopedic surgeries following diagnosis in cases of adult-onset RA in Olmsted County, Minnesota, USA, in 1980-2007. Surgeries included primary total joint arthroplasty, joint reconstructive procedures (JRP), soft tissue procedures (STP), and revision arthroplasty. Cumulative incidence of surgery was estimated using Kaplan-Meier methods. Time trends, sex differences, and mortality were examined using Cox models with time-dependent covariates for surgery.
A total of 189 of 813 patients underwent at least 1 surgical procedure involving joints during followup. The cumulative incidence of any joint surgery at 10 years after RA incidence for the 1980-94 cohort was 27.3% compared to 19.5% for the 1995-2007 cohort (p = 0.08). The greatest reduction was in STP, which decreased from 12.1% in 1980-94 to 6.0% in 1995-2007 at 10 years after RA incidence (p = 0.012). Women had more surgery (cumulative incidence 26.6% at 10 years for women; 20.4% for men; p = 0.049), as did obese patients. JRP were significantly associated with mortality (hazard ratio 2.6; 95% CI 1.8, 3.9; p < 0.001) compared to patients not requiring JRP.
The rates of joint surgery continue to decrease for patients more recently diagnosed with RA. JRP is associated with increased mortality. These findings may reflect improved treatments for RA as well as continued higher disease burden among some patients.
描述类风湿关节炎（RA）患者人群中与关节炎相关的关节手术的当前趋势，并研究关节手术对死亡率的影响。
对美国明尼苏达州奥姆斯特德县 1980-2007 年成年发病的 RA 患者的所有骨科手术后进行回顾性病历审查。手术包括初次全关节置换术、关节重建术（JRP）、软组织手术（STP）和翻修关节置换术。使用 Kaplan-Meier 方法估计手术的累积发生率。使用 Cox 模型检查时间趋势、性别差异和死亡率，并使用时间依赖性协变量对手术进行分析。
在随访期间，共有 813 名患者中的 189 名接受了至少 1 次关节手术。1980-94 队列中，RA 发病后 10 年时任何关节手术的累积发生率为 27.3%，而 1995-2007 队列中为 19.5%（p = 0.08）。最大的减少发生在 STP，1980-94 年的发生率为 12.1%，而 1995-2007 年 RA 发病后 10 年时的发生率为 6.0%（p = 0.012）。女性手术更多（女性 10 年累积发生率为 26.6%，男性为 20.4%；p = 0.049），肥胖患者也是如此。与不需要 JRP 的患者相比，JRP 与死亡率显著相关（风险比 2.6；95%CI 1.8，3.9；p < 0.001）。
最近被诊断为 RA 的患者的关节手术率继续下降。JRP 与死亡率增加相关。这些发现可能反映了 RA 治疗的改善以及某些患者疾病负担的持续增加。
