Early referral and control of disease's flares prevent Orthopedic and Hand Surgery Indication (OHSI) in a dynamic cohort of Hispanic early rheumatoid arthritis patients

• Published in: BMC musculoskeletal disorders 2018-10, Vol.19 (1), p.378-378, Article 378
• Main Authors: Contreras-Yáñez, Irazú, Guaracha-Basáñez, G, Díaz-Borjón, E, Iglesias, M, Pascual-Ramos, V
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - therapy; Autoantibodies; Bone surgery; Care and treatment; Case-Control Studies; Disease flares; Early referral; Family medical history; Female; Follow-Up Studies; Hand Joints - pathology; Hand Joints - surgery; Hand surgery; Health aspects; Hispanic Americans - statistics & numerical data; Hispanic people; Humans; Incidence; Joint surgery; Laboratories; Latin Americans; Male; Mexico - epidemiology; Middle Aged; Musculoskeletal diseases; Orthopedic Procedures - statistics & numerical data; Orthopedic surgery; Orthopedic surgery predictors; Orthopedics; Patients; Prevalence studies (Epidemiology); Prognosis; Prospective Studies; Reconstructive surgery; Reconstructive Surgical Procedures - statistics & numerical data; Referral and Consultation - statistics & numerical data; Rheumatoid arthritis; Severity of Illness Index; Studies; Surgery; Symptom Flare Up; Time Factors
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-018-2299-9

Reconstructive joint surgery is an indicator of poor prognosis in rheumatoid arthritis (RA). Objectives of this study were to describe the incidence rate of orthopedic and hand surgery indication (OHSI) in an ongoing cohort of Hispanic early RA patients treated according to a T2T strategy and to investigate predictors. Through February 2018, the cohort comprised 185 patients recruited from 2004 onwards, with variable follow-up, and rheumatic assessments at fixed intervals that included prospective determination of OHSI. Charts were reviewed by a single data abstractor. OHSI incidence rate was calculated. A case-control study nested within a cohort investigated the predictors; cases (OHSI patients) were paired with controls (1:4) according to age, sex and autoantibodies. A logistic regression model included baseline and cumulative (up to OHSI or equivalent) variables related to disease activity, treatment and to persistence with therapy. The IRB approved the study. Patients from the cohort were predominantly middle-aged (mean ± SD age: 38.5 ± 12.9 years) females (87.6%) with 5.4 ± 2.6 months of disease duration. The cohort contributed to 1538 patient-years of follow-up. Twelve patients received incidental OHSI at a follow-up of 85 ± 44.5 months. The OHSI incident global rate was 8/1000 patient-years. Longer symptom duration at cohort referral (OR: 1.313, 95%CI: 1.02-1.68, p = 0.032) and a higher number of flares/patient (OR: 1.608, 95%CI: 1.05-1.61, p = 0.015) predicted OHSI. OHSI patients had more severe flares than their counterparts, and the opposite figure was true for mild flares. Early referral for appropriate management and flare control may prevent OHSI in Hispanic recent-onset RA patients.