类风湿关节炎患者行全膝关节和全髋关节置换术的风险：一项 65898 例患者的 12 年回顾性队列研究。

Risk of Total Knee and Hip Arthroplasty in Patients With Rheumatoid Arthritis: A 12-Year Retrospective Cohort Study of 65,898 Patients.

机构信息

Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan; Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan; Department of Center for General Education, National United University, Miaoli, Taiwan.

Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.

出版信息

J Arthroplasty. 2020 Dec;35(12):3517-3523. doi: 10.1016/j.arth.2020.06.085. Epub 2020 Jul 3.

DOI:10.1016/j.arth.2020.06.085

PMID:32778419

Abstract

BACKGROUND

Rheumatoid arthritis (RA) is an inflammatory disease that causes the destruction of soft tissues and cartilage around joints. Owing to the widespread use of potent disease-modifying antirheumatic drugs, the need for total knee and hip arthroplasties (TKA and THA) has been reduced in patients with RA. However, the current association between RA and either THA or TKA has not been demonstrated in large-scale epidemiological studies.

METHODS

We conducted a large-scale retrospective cohort study of patients diagnosed with RA during a 12-year period (2000-2012) in Taiwan. We recruited 32,949 patients with RA and 32,949 individually propensity score-matched non-RA controls.

RESULTS

After adjusting for confounding factors, we found that the risk of THA or TKA was 4.02 times higher in patients with RA than in those without RA (95% confidence interval [CI], 3.77-4.52). The risk of THA or TKA was highest in patients with RA younger than 40 years (adjusted hazard ratio, 43.18; 95% CI, 16.01-116.47). Compared with non-RA patients, patients with RA were 4.82 times more likely to undergo THA (95% CI, 3.84-6.04), 3.85 times more likely to undergo TKA (95% CI, 3.48-4.25), and 19.06 times more likely to undergo both THA and TKA (95% CI, 8.90-40.80).

CONCLUSION

These findings document a 4.02-fold greater long-term risk of undergoing THA or TKA in RA patients relative to non-RA patients in Taiwan.

摘要

背景

类风湿关节炎（RA）是一种炎症性疾病，可导致关节周围的软组织和软骨破坏。由于广泛使用强效的疾病修饰抗风湿药物，RA 患者进行全膝关节和髋关节置换术（TKA 和 THA）的需求已经减少。然而，在大规模的流行病学研究中尚未证明 RA 与 THA 或 TKA 之间存在关联。

方法

我们进行了一项大规模的回顾性队列研究，纳入了台湾在 12 年内（2000-2012 年）诊断为 RA 的患者。我们招募了 32949 例 RA 患者和 32949 例个体倾向评分匹配的非 RA 对照。

结果

在调整混杂因素后，我们发现 RA 患者进行 THA 或 TKA 的风险是无 RA 患者的 4.02 倍（95%置信区间[CI]，3.77-4.52）。在年龄小于 40 岁的 RA 患者中，THA 或 TKA 的风险最高（调整后的危险比，43.18；95%CI，16.01-116.47）。与非 RA 患者相比，RA 患者行 THA 的可能性是后者的 4.82 倍（95%CI，3.84-6.04），行 TKA 的可能性是后者的 3.85 倍（95%CI，3.48-4.25），同时行 THA 和 TKA 的可能性是后者的 19.06 倍（95%CI，8.90-40.80）。