Fewer and older patients with rheumatoid arthritis need total knee replacement

Jul 26, 2012Scandinavian journal of rheumatology

Fewer and older rheumatoid arthritis patients require total knee replacement

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Abstract

The annual incidence of total knee replacements (TKRs) for rheumatoid arthritis (RA) decreased from 19.6 to 10.8 per 100,000 person-years from 1992 to 2010.

Overall incidence of TKRs increased 20-fold from 14.2 to 305.3 operations per 100,000 person-years between 1980 and 2010.
The decrease in TKR incidence for RA was more pronounced in women and individuals aged 60 years and older.
The mean age at the time of TKR for RA patients rose over the study period, aligning more closely with the age of patients undergoing TKR for osteoarthritis (OA).
These trends may indicate an improvement in long-term outcomes for patients with RA.

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OBJECTIVES: Recent studies have suggested a decreased need for orthopaedic surgery in patients with rheumatoid arthritis (RA). We analysed trends in total knee replacement (TKR) in RA using TKR in osteoarthritis (OA) as a point of reference.

METHODS: Data on TKRs from the Finnish Arthroplasty Register and population data from Statistics Finland were used to analyse the trends in TKRs among patients aged ≥ 40 years with primary osteoarthritis (OA) or RA in Finland for the period from 1980 to 2010.

RESULTS: During 1980-2010, the overall incidence of TKRs increased 20-fold from 14.2 to 305.3 operations per 10(5) person-years. After peaking in 1992, the annual incidence of TKRs for RA decreased gradually from 19.6 to 10.8 per 10(5) [incidence rate ratio (IRR) 0.97, p < 0.001]. The decrease was more pronounced in women and the older (≥ 60 years) age group. The mean age at the time of TKR among patients with RA increased over time, converging with that of patients with OA.

CONCLUSION: There is a clear decrease in the annual incidence of TKRs in RA, while among OA patients the incidence is increasing steadily. Furthermore, patients with RA seem to receive their TKRs at an older age. Both of these findings suggest improving long-term outcome in RA.

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Fewer and older patients with rheumatoid arthritis need total knee replacement

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