From the University of Alabama at Birmingham (UAB) divisions of Orthopaedic Surgery, and Clinical Immunology and Rheumatology, and the Department of Epidemiology, Birmingham, Alabama; and the Carolinas Medical Center Department of Orthopaedic Surgery, Charlotte, North Carolina, USA.
B.L. Young, MD, Resident, Carolinas Medical Center Department of Orthopaedic Surgery; S.L. Watson, BA, Research Fellow, UAB Division of Orthopaedic Surgery; J.L. Perez, MD, Research Fellow, UAB Division of Orthopaedic Surgery; G. McGwin, MS, PhD, Professor and Vice Chairman, UAB Department of Epidemiology; J.A. Singh, MBBS, MPH, Professor, UAB Division of Clinical Immunology and Rheumatology; B.A. Ponce, MD, Associate Professor, UAB Division of Orthopaedic Surgery.
J Rheumatol. 2018 Feb;45(2):158-164. doi: 10.3899/jrheum.170001. Epub 2017 Dec 1.
This study analyzed trends in large total joint arthroplasties (TJA) and in the proportion of these procedures performed on patients with rheumatoid arthritis (RA).
The US Nationwide Inpatient Sample (2002-2012) was used to identify the incidences of total shoulder (TSA), elbow (TEA), knee (TKA), hip (THA), and ankle (TAA) arthroplasty and the proportion of these performed with coexisting RA.
The prevalence of RA among patients with TJA increased 3.0%. The prevalence of RA among cases of TEA and TSA decreased by 50% (p < 0.0001) and 18% (p = 0.0016), respectively; a 38.0% decrease occurred in the prevalence of RA among TAA (p = 0.06); and nonsignificant increases were seen among THA and TKA. The average age difference between RA and non-RA patients undergoing TJA narrowed by 2 years (p < 0.0001). There was a greater reduction in the proportion of TSA, TEA, and TAA groups among women with RA than men with RA. In the TSA and TEA groups, there was a reduction in the proportion of whites with RA, but not blacks. The proportion of privately insured TSA and TAA patients with RA decreased, while patients with RA undergoing TSA, TEA, or TAA who were receiving Medicaid (government medical insurance) remained relatively stable over time.
The prevalence of RA has decreased among TSA and TEA patients. A nonsignificant decline occurred among TAA patients. The average age of TJA patients with RA is beginning to mirror those without RA. Sex ratios for TSA, TEA, and TAA patients are following a similar pattern. These results may be evidence of the success of modern RA treatment strategies.
本研究分析了大关节置换术（TJA）的趋势以及这些手术在类风湿关节炎（RA）患者中的比例。
本研究使用美国全国住院患者样本（2002-2012 年）确定了全肩关节置换术（TSA）、肘关节置换术（TEA）、膝关节置换术（TKA）、髋关节置换术（THA）和踝关节置换术（TAA）的发病率，以及这些手术中同时存在 RA 的比例。
RA 患者接受 TJA 的患病率增加了 3.0%。TEA 和 TSA 病例中 RA 的患病率分别下降了 50%（p < 0.0001）和 18%（p = 0.0016）；TAA 中 RA 的患病率下降了 38.0%（p = 0.06）；THA 和 TKA 中则未出现显著变化。接受 TJA 的 RA 患者和非 RA 患者之间的平均年龄差异缩小了 2 岁（p < 0.0001）。在 RA 女性患者中，TSA、TEA 和 TAA 组的比例下降幅度大于 RA 男性患者。在 TSA 和 TEA 组中，RA 白人患者的比例有所下降，但黑人患者的比例没有下降。接受 TSA 和 TAA 的 RA 私人保险患者的比例下降，而接受 Medicaid（政府医疗保险）的接受 TSA、TEA 或 TAA 的 RA 患者比例保持相对稳定。
TSA 和 TEA 患者中 RA 的患病率有所下降。TAA 患者的患病率出现了无统计学意义的下降。RA 患者 TJA 的平均年龄开始与非 RA 患者相匹配。TSA、TEA 和 TAA 患者的性别比例也呈现出类似的模式。这些结果可能是现代 RA 治疗策略成功的证据。
