The Longterm Effect of Early Intensive Treatment of Seniors with Rheumatoid Arthritis: A Comparison of 2 Population-based Cohort Studies on Time to Joint Replacement Surgery

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The Longterm Effect of Early Intensive Treatment of Seniors with Rheumatoid Arthritis: A Comparison of 2 Population-based Cohort Studies on Time to Joint Replacement Surgery
Key Take-Away: 

Rheumatoid arthritis (RA) is a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility in the fingers, wrists, feet, and ankles. This study predicted that the early detection and diagnosis of RA will further prevent the surgery in the later stages of this diseases. The Disease-modifying anti-rheumatic drugs (DMARD) have been analyzed here.

Disease-modifying anti-rheumatic drugs (DMARD) have the greatest effect when initiated early.

ABSTRACT: 
Background: 

Disease-modifying anti-rheumatic drugs (DMARD) have the greatest effect when initiated early.

We evaluated the influence of early exposure to DMARD on time to joint replacement surgery among patients with incident rheumatoid arthritis (RA).

Methods: 

Using a common protocol, we undertook 2 independent population-based cohort studies of patients with incident RA aged 66 years or older in Ontario (ON) and Quebec (QC) covering the period 2000–2013.

We used Cox proportional hazards regression with time-dependent variables measuring duration of drug use in the first year, separately for methotrexate (MTX) and other DMARD, adjusting for baseline demographics, clinical factors, and other potentially confounding drug exposures. Our outcome measure was any joint replacement derived from standardized procedure codes. Adjusted HR and 95% CI were estimated.

Results: 

Among 20,918 ON and 6754 QC patients with RA followed for a median of 4.5 years, 2201 and 494 patients underwent joint replacement surgery for crude event rates of 2.0 and 1.4 per 100 person-years, respectively.

Greater cumulative exposure to MTX (HR 0.97, 95% CI 0.95–0.98) and other DMARD (HR 0.98, 95% CI 0.97–0.99) in the first year after diagnosis was associated with longer times to joint replacement in ON, corresponding to a 2–3% decrease in the hazard of surgery with each additional month of early use. Similar results were observed in QC.

Conclusion: 

Greater duration of exposure to DMARD soon after RA diagnosis was associated with delays to joint replacement surgery in both provinces.

Early intensive treatment of RA may ultimately reduce demand for joint replacement surgery.

J Rheumatol. 2016 May;43(5):861-8

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