Rheumatoid arthritis can damage joints to such as extent
that some people have to undergo joint replacement. A number of new medications like Tumor Necrosis Factor (TNF)
inhibitors have been available during the recent years that prevent joint destruction
and help to avoid surgery.
Studies indicate that in recent times, the need for total
hip or knee replacement has come down to a large extent in patients with rheumatoid
arthritis, probably due to the available medical treatment.
Dr. Korosh Hekmat from Skane University Hospital, Sweden
and colleagues investigated the trends in the incidence of total hip and knee
arthroplasties in a well defined sample of patients with rheumatoid arthritis (RA).
For the study, subjects with
rheumatoid arthritis, registered between 1997 and 2007 were included. Patients
were classified according to the 1987 ACR criteria for rheumatoid arthritis.
Patients who were registered with a total hip or knee arthroplasty before 1997
or before the diagnosis of rheumatoid arthritis were excluded. The incidence of registered total hip and
knee arthroplasties were compared between the time period 1998 - 2001 when TNF
inhibitors were introduced with the period between 2002 - 2006 (for total hip
arthroplasties) / 2007 (for total knee arthroplasties) when biologics were
established for the treatment of severe rheumatoid arthritis.
Study reports indicated that in
the cohort (n=2164; 71% women) a primary hip arthroplasty was registered for
115 subjects and a primary knee arthroplasty for 82 subjects during the total
study period. The incidence of total hip arthroplasties significantly decreased
from the period of 1998-2001 to 2002-2006. However, the total knee arthroplasties increased slightly during
The authors concluded the study
by reporting, "The investigation shows a significant decrease in the incidence
of total hip arthroplasties in patients with rheumatoid arthritis after 2001.
The possible explanations to this include a positive effect on joint damage
from a more aggressive pharmacological treatment."