类风湿关节炎患者骨科手术治疗、结局和发生率的变化趋势：一项基于日本风湿病数据库的观察性队列研究。
Trends in Treatment, Outcomes, and Incidence of Orthopedic Surgery in Patients with Rheumatoid Arthritis: An Observational Cohort Study Using the Japanese National Database of Rheumatic Diseases.
机构信息
From the Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo; Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization, Miyazaki; Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.
T. Matsumoto, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Nishino, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; N. Izawa, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; M. Naito, MD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; J. Hirose, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; S. Tanaka, MD, PhD, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo; T. Yasui, MD, PhD, Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital; K. Saisho, MD, PhD, Department of Rheumatology, Miyakonojo Medical Center, National Hospital Organization; S. Tohma, MD, PhD, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization.
出版信息
J Rheumatol. 2017 Nov;44(11):1575-1582. doi: 10.3899/jrheum.170046. Epub 2017 Sep 1.
OBJECTIVE
In this study, we investigated the changes in clinical outcome, treatment, and incidence of orthopedic surgery in patients with rheumatoid arthritis (RA) from 2004 to 2014.
METHODS
Data were studied from the Japanese nationwide cohort database, NinJa (National Database of Rheumatic Diseases by iR-net in Japan), from 2004 to 2014. The time trends in the incidence of orthopedic procedures were analyzed using linear regression analysis. The cross-sectional annual data were compared between 2004 and 2014 to analyze the changes in clinical outcome and treatment.
RESULTS
The incidence of orthopedic surgeries in patients with RA consistently decreased from 72.2 procedures per 1000 patients in 2004 to 51.5 procedures per 1000 patients in 2014 (regression coefficient = -0.0028, 95% CI -0.0038 to -0.0019, p < 0.001). The greatest reduction was found in total knee arthroplasty and total hip arthroplasty. Disease activity and functional disability improved significantly over this decade. The proportions of patients receiving methotrexate and biologic disease-modifying antirheumatic drugs significantly increased from 39.6% and 1.7% in 2004 to 63.8% and 27.4% in 2014, respectively.
CONCLUSION
The overall incidence of orthopedic surgeries in patients with RA significantly decreased, accompanied by improved clinical outcomes because of the expanded use of effective drugs; however, the declining trend differed between procedures or locations. The results from the present study suggest that there might be a change in supply and demand for orthopedic surgeries.
目的
本研究旨在调查 2004 年至 2014 年期间类风湿关节炎（RA）患者的临床结局、治疗方法和骨科手术发生率的变化。
方法
本研究数据来自日本全国性队列数据库 NinJa（日本 iR-net 风湿疾病全国数据库），时间范围为 2004 年至 2014 年。采用线性回归分析方法分析骨科手术发生率的时间趋势。通过比较 2004 年和 2014 年的横断面年度数据，分析临床结局和治疗方法的变化。
结果
RA 患者的骨科手术发生率持续下降，从 2004 年的每 1000 例患者 72.2 例降至 2014 年的每 1000 例患者 51.5 例（回归系数=-0.0028，95%CI-0.0038 至-0.0019，p<0.001）。全膝关节置换术和全髋关节置换术的降幅最大。在这十年中，疾病活动度和功能障碍显著改善。接受甲氨蝶呤和生物 DMARDs 的患者比例分别从 2004 年的 39.6%和 1.7%显著增加到 2014 年的 63.8%和 27.4%。
结论
RA 患者的总体骨科手术发生率显著下降，这与有效药物的广泛应用导致临床结局改善有关；然而，不同手术或部位的下降趋势存在差异。本研究结果表明，骨科手术的供需关系可能发生了变化。
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