Variability in the use of orthopedic surgery in patients with rheumatoid arthritis in Spain

• Published in: Journal of rheumatology 2007-07, Vol.34 (7), p.1485-1490
• Main Authors: Estibaliz Loza, Lydia Abásolo, Daniel Clemente, Ruth López-González, Luis Rodríguez, Cristina Vadillo, Benjamin Fernández-Gutiérrez, Pilar Macarrón, Juan A Jover, César Hernández-García
• Format: Article
• Language: English
• Subjects: Adult; Arthritis, Rheumatoid - physiopathology; Arthritis, Rheumatoid - surgery; Arthroplasty, Replacement - statistics & numerical data; Arthroplasty, Replacement - utilization; Biological and medical sciences; Demography; Diseases of the osteoarticular system; Female; Humans; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Orthopedic Procedures - statistics & numerical data; Orthopedic Procedures - utilization; Orthopedic surgery; Retrospective Studies; Sex Factors; Spain; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 0315-162X; 1499-2752

OBJECTIVE: To analyze sociodemographic and clinic-associated factors of patients with rheumatoid arthritis (RA) undergoing any orthopedic surgery (AOS) and total joint replacement (TJR) in Spain. METHODS: A retrospective medical record review was performed in a probabilistic sample of 1379 RA patients from 46 centers distributed in 16 of 19 regions in Spain. Sociodemographic and clinical features, use of drugs, and arthritis-related joint surgeries were recorded following a standardized protocol. Gross domestic product (GDP) data were obtained from the National Statistical Index. RESULTS: Of 1379 patients, a total of 358 (26%) underwent one or more joint surgeries, and 194 (14%) had a TJR. The median time to first orthopedic procedure was 12.5 years from presentation of RA and the estimated rate was 5.6 surgeries per 100 person-years. The rate of AOS was increased in women, patients with RA with extraarticular complications, with longterm RA (> 10 yrs), with functional grade III-IV, and with persistent inflammatory disease. The risk factors for undergoing a TJR were longterm RA, functional grade III-IV, and extraarticular complications. Patients from regions with higher GDP per capita were more likely to undergo a procedure. CONCLUSION: Clinical variables reflecting disease activity and severity are predictors of orthopedic surgery, but geographic and socioeconomic variables were also independently associated with the rate of orthopedic surgery.