Singh Jasvinder A, Cleveland John
University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA.
Department of Medicine at the School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, USA.
Ther Adv Musculoskelet Dis. 2021 Feb 25;13:1759720X20973916. doi: 10.1177/1759720X20973916. eCollection 2021.
To examine the secular trends in the number and rates of in-hospital cardiac and orthopedic procedures in people with gout and rheumatoid arthritis (RA), and the United States (US) general population, from 1998 to 2014.
We examined the frequency of seven common cardiac and orthopedic procedures in hospitalized people with gout, RA, or the general population using the 1998-2014 US National Inpatient Sample (NIS). Poisson regression evaluated the differences in frequencies in 1998 2014, between gout and RA, and within each cohort.
Both in-hospital cardiac and orthopedic procedures increased in gout and RA with time, in contrast with declining cardiac procedures in the general US population. Cardiac procedures were significantly higher in gout RA in 1998 (59% higher) and 2014 (92% higher). The rate of cardiac procedures increased from 36.6 to 82.8 in gout and from 20.1 to 33.1 in RA per 100,000 NIS claims from 1998 to 2014. Orthopedic procedures became more common than cardiac procedures in gout and RA by 2014. In RA, the cardiac-orthopedic procedure volume difference was significant in 1998 and 2014. We noted no significant difference between cardiac orthopedic procedures in 1998 in gout, but the difference was significant in 2014. Orthopedic procedures in gout were significantly lower than RA in 1998 (33% lower), but were significantly higher than RA in 2014 (5% higher).
Increasing in-hospital cardiac procedures in gout and RA contrasting with declining general US population rates indicated that optimal management of systemic inflammation and an early diagnosis of gout and RA are needed. The rate of increase in orthopedic procedures exceeded that in cardiac procedures. A much greater volume and rate of increase in common in-hospital cardiac and orthopedic procedures in gout compared to RA indicates that an aggressive approach to treat-to-target in gout is needed to potentially reduce the associated healthcare burden and cost.
We performed a national US study of the most common cardiac versus orthopedic procedures from 1998 to 2014. We found that over time, the number and the rate of cardiac procedures increased in people with gout (2.2-fold higher) or rheumatoid arthritis (1.6-fold higher). This was surprising, since during the same time, we noted a decrease in cardiac procedures in the general U.S. population. The rate of cardiac procedures in gout was 2.5-fold higher than that in rheumatoid arthritis, 82.8 vs. 33.1 per 100,000 NIS claims in 2014. Interestingly, orthopedic procedures were more common than cardiac procedures in both gout and RA in all periods. Also, the difference in the numbers of cardiac vs. orthopedic procedures increased over time in both gout and RA. Gout outpaced rheumatoid arthritis for both the total number and the rate of cardiac or orthopedic procedures over time. Therefore, our study provides an understanding of an increasing procedure burden in gout compared to rheumatoid arthritis, and to the general U.S. people with these conditions.
研究1998年至2014年期间，痛风和类风湿关节炎（RA）患者以及美国普通人群住院心脏和骨科手术数量及发生率的长期趋势。
我们使用1998 - 2014年美国国家住院样本（NIS），研究痛风、RA患者或普通人群中七种常见心脏和骨科手术的发生频率。泊松回归分析评估了1998年至2014年期间痛风与RA之间以及各队列内部频率的差异。
痛风和RA患者的住院心脏和骨科手术数量均随时间增加，而美国普通人群的心脏手术数量呈下降趋势。1998年痛风和RA患者的心脏手术数量显著高于普通人群（高59%），2014年高92%。1998年至2014年，痛风患者每10万份NIS索赔中，心脏手术发生率从36.6增至82.8，RA患者从20.1增至33.1。到2014年，痛风和RA患者的骨科手术比心脏手术更常见。在RA中，1998年和2014年心脏手术与骨科手术数量差异显著。我们发现1998年痛风患者心脏手术与骨科手术数量无显著差异，但2014年差异显著。1998年痛风患者的骨科手术显著低于RA患者（低33%），但2014年显著高于RA患者（高5%）。
痛风和RA患者住院心脏手术数量增加，与美国普通人群下降趋势形成对比，这表明需要对全身炎症进行优化管理，并早期诊断痛风和RA。骨科手术的增加率超过心脏手术。与RA相比，痛风患者住院常见心脏和骨科手术数量及增加率更高，这表明需要采取积极的达标治疗方法来降低痛风相关的医疗负担和成本。
我们对1998年至2014年美国最常见的心脏手术与骨科手术进行了全国性研究。我们发现，随着时间推移，痛风患者（高2.2倍）或类风湿关节炎患者（高1.6倍）的心脏手术数量和发生率增加。这令人惊讶，因为同期美国普通人群的心脏手术数量减少。2014年，痛风患者每10万份NIS索赔中，心脏手术发生率为82.8，类风湿关节炎患者为33.1，痛风患者是类风湿关节炎患者的2.5倍。有趣的是，在所有时期，痛风和RA患者的骨科手术都比心脏手术更常见。此外，痛风和RA患者心脏手术与骨科手术数量差异随时间增加。随着时间推移，痛风患者心脏或骨科手术的总数和发生率均超过类风湿关节炎患者。因此，我们的研究揭示了与类风湿关节炎相比，痛风患者手术负担不断增加，以及这些疾病在美国普通人群中的情况。
