Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA; Department of Orthopaedic Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA.
J Shoulder Elbow Surg. 2023 Oct;32(10):2132-2139. doi: 10.1016/j.jse.2023.05.020. Epub 2023 Jun 20.
Total elbow arthroplasty (TEA) is often used to manage advanced arthropathies of the elbow caused by inflammatory conditions such as rheumatoid arthritis (RA). Recent literature has shown that use of TEA is decreasing in patients with RA, part of which can be attributed to early medical management involving disease-modifying antirheumatic drugs (DMARDs). However, there is a significant economic barrier to accessing DMARD therapy. The purpose of this study was to compare the use of TEA between patients with and without DMARD therapy from 2010 to 2020.
A retrospective cohort analysis was performed using a national insurance claim database to investigate the trends of patients with RA undergoing TEA from 2010-2020. Patients who underwent TEA and had a diagnosis of RA were identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD)-9 and ICD-10 codes between 2010 and 2020. These patients were then stratified into 2 cohorts: those with DMARD prescription claims and those without. A linear regression, compound annual growth rate (CAGR) analysis, and χ analysis were conducted to compare trends and demographic variables, including insurance type, between cohorts. Additionally, a multivariable logistic regression was subsequently performed to observe odds ratios (ORs) and 95% confidence intervals.
From 2010 to 2020, there has been no significant change in the incidence of TEA in RA patients without DMARD prescriptions, whereas there has been a statistically significantly decreasing rate of TEA observed in RA patients with DMARD prescription claims. The analysis showed that there was a CAGR of -4%. For patients with a diagnosis of RA and DMARD prescription claims, the highest incidence of undergoing TEA was seen in the age group of 60-69 years, whereas patients with a diagnosis of RA and no DMARD prescription claims had the highest incidence of undergoing TEA in the age group of 70-79 years.
The incidence of patients undergoing TEA with a diagnosis of RA and DMARD prescription claims has shown a statistically significant decrease from 2010 to 2020, whereas no significant difference was observed for patients without DMARD prescription claims. There were no statistically significant differences in the insurance plans between cohorts.
全肘关节置换术（TEA）常用于治疗由类风湿关节炎（RA）等炎症性疾病引起的晚期肘关节炎。最近的文献表明，RA 患者使用 TEA 的比例正在下降，部分原因是早期的疾病治疗包括使用改变病情的抗风湿药物（DMARDs）。然而，获得 DMARD 治疗存在显著的经济障碍。本研究旨在比较 2010 年至 2020 年间有和无 DMARD 治疗的 RA 患者使用 TEA 的情况。
使用国家保险索赔数据库进行回顾性队列分析，调查 2010-2020 年间接受 TEA 的 RA 患者的趋势。使用当前程序术语（CPT）和国际疾病分类（ICD）-9 和 ICD-10 代码，在 2010 年至 2020 年间确定接受 TEA 且诊断为 RA 的患者。然后，将这些患者分为两组：有 DMARD 处方和无 DMARD 处方。进行线性回归、复合年增长率（CAGR）分析和 χ 检验，比较两组之间的趋势和人口统计学变量，包括保险类型。此外，还进行了多变量逻辑回归，以观察比值比（OR）和 95%置信区间。
2010 年至 2020 年，无 DMARD 处方的 RA 患者 TEA 的发病率没有显著变化，而有 DMARD 处方的 RA 患者 TEA 的发病率呈统计学显著下降趋势。分析表明，其 CAGR 为-4%。对于诊断为 RA 且有 DMARD 处方的患者，接受 TEA 的最高发病率出现在 60-69 岁年龄组，而诊断为 RA 且无 DMARD 处方的患者接受 TEA 的最高发病率出现在 70-79 岁年龄组。
诊断为 RA 且有 DMARD 处方的患者接受 TEA 的发病率从 2010 年至 2020 年呈统计学显著下降，而无 DMARD 处方的患者则无显著差异。两组之间的保险计划没有统计学上的显著差异。
