类风湿关节炎髋关节和膝关节置换的描述性流行病学：英国电子病历分析。

Descriptive epidemiology of hip and knee replacement in rheumatoid arthritis: An analysis of UK electronic medical records.

机构信息

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.

NIHR Clinical Research Facility, University Hospital Southampton, Southampton, United Kingdom.

出版信息

Semin Arthritis Rheum. 2020 Apr;50(2):237-244. doi: 10.1016/j.semarthrit.2019.08.008. Epub 2019 Aug 26.

DOI:10.1016/j.semarthrit.2019.08.008

PMID:31492436

Abstract

OBJECTIVE

To provide descriptive data on rates of total hip replacement (THR) and total knee replacement (TKR) within a large RA cohort and describe variation in risk.

METHODS

Incident RA patients (1995 to 2014) were identified from the Clinical Practice Research Datalink (CPRD). First subsequent occurrence of THR and TKR were identified (analysed separately) and incidence rates calculated, stratified by sex, age, BMI, geographic region, and quintiles of the index of multiple deprivation (IMD) score.

RESULTS

There were 27,607 RA patients included, with a total of 1,028 THRs (mean age at surgery: 68.4 years) and 1,366 TKRs (mean age at surgery: 67.6 years), at an overall incidence rate per 1,000 person-years (PYs) [95% CI] of 6.38 [6.00-6.78] and 8.57 [8.12-9.04], respectively. TKR incidence was similar by gender but THR rates were higher in females than males. Rates of TKR but not THR rose according to BMI. An increasing trend was observed in rates of both outcomes according to age (although not ≥75) but of decreasing rates according to socio-economic deprivation. There was some evidence for regional variation in TKR. The 10-year cumulative incidence was 5.2% [4.9, 5.6] and 7.0% [6.6, 7.4] for THR and TKR, respectively.

CONCLUSION

We provide generalizable estimates of THR and TKR incidence in the UK RA patient population and note variation across several key variables. Increased BMI was associated with a large increase in TKR but not THR incidence. Increased deprivation was associated with a downward trend in rates of THR and TKR.

摘要

目的

提供大量类风湿关节炎患者队列中全髋关节置换术（THR）和全膝关节置换术（TKR）的发生率数据，并描述风险的变化。

方法

从临床实践研究数据库（CPRD）中确定了类风湿关节炎患者（1995 年至 2014 年）。单独分析（分别分析）并计算首次发生 THR 和 TKR 的后续发生率，并按性别、年龄、BMI、地理位置和多重剥夺指数（IMD）得分五分位数进行分层。

结果

共纳入 27607 例 RA 患者，共进行 1028 例 THR（手术时平均年龄：68.4 岁）和 1366 例 TKR（手术时平均年龄：67.6 岁），每 1000 人年（PY）[95%CI]的总发生率分别为 6.38 [6.00-6.78]和 8.57 [8.12-9.04]。性别之间的 TKR 发生率相似，但女性 THR 发生率高于男性。TKR 发生率随 BMI 增加而增加，但 THR 发生率不受 BMI 影响。两种结局的发生率均随年龄增加呈上升趋势（尽管年龄≥75 岁除外），但随社会经济剥夺程度降低呈下降趋势。TKR 发生率存在一定的地域差异。THR 和 TKR 的 10 年累积发生率分别为 5.2%[4.9,5.6]和 7.0%[6.6,7.4]。