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Pina Vegas L, Iggui S, Sbidian E, Claudepierre P. Impact of initiation of targeted therapy on the use of psoriatic arthritis-related treatments and healthcare consumption: a cohort study of 9793 patients from the French health insurance database (SNDS). RMD Open 2024; 10:e004631. [PMID: 39117446 PMCID: PMC11409354 DOI: 10.1136/rmdopen-2024-004631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES To assess the potential impact of targeted therapies for psoriatic arthritis (PsA) on symptomatic treatments (non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, opioid analgesics), methotrexate and mood disorder treatments and on hospitalisation and sick leave. METHODS Using the French health insurance database, this nationwide cohort study included adults with PsA who were new users (not in the year before the index date) of targeted therapies for ≥9 months during 2015-2021. Main endpoints were difference in proportion of users of associated treatments, hospitalisations and sick leaves between 3 and 9 months after and 6 months before targeted therapy initiation. Logistic regression models adjusted for sex, age, psoriasis, inflammatory bowel disease and Charlson Comorbidity Index compared the impact of biologics initiation (tumour necrosis factor inhibitor (TNFi)/interleukin 17 inhibitor (IL17i)/IL12/23i) on associated treatment discontinuation. RESULTS Among 9793 patients initiating targeted therapy for PsA (mean age: 51±13 years, 47% men), 62% initiated TNFi, 14% IL17i, 10% IL12/23i, 1% Janus kinase inhibitor, 12% phosphodiesterase-4 inhibitor. After treatment initiation, the proportion of treatment users was significantly reduced for NSAIDs (-15%), opioid analgesics (-9%), prednisone (-9%), methotrexate (-15%) and mood disorder treatments (-2%), along with decreased hospitalisations (-12%) and sick leaves (-4%). TNFi had a greater sparing effect on NSAIDs and prednisone use than IL17i (ORa=1.04, 95% CI=1.01 to 1.07; 1.04, 1.02 to 1.06) and IL12/23i (1.07, 1.04 to 1.10; 1.06, 1.04 to 1.09). Odds of methotrexate discontinuation was reduced with TNFi versus IL17i (0.96, 0.94 to 0.98) and IL12/23i (0.94, 0.92 to 0.97). CONCLUSIONS Targeted therapy initiation for PsA reduced the use of associated treatment and healthcare, with TNFi having a slightly greater effect than IL17i and IL12/23i, except for methotrexate discontinuation.
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Affiliation(s)
- Laura Pina Vegas
- Service de Rhumatologie, Hôpital Henri Mondor, Créteil, Île-de-France, France
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, Île-de-France, France
| | - Siham Iggui
- Service de Rhumatologie, Hôpital Henri Mondor, Créteil, Île-de-France, France
| | - Emilie Sbidian
- Inserm, Centre d'investigation clinique 1430, Hôpital Henri Mondor, Créteil, Île-de-France, France
- Service de Dermatologie, Hôpital Henri Mondor, Créteil, Île-de-France, France
| | - Pascal Claudepierre
- Service de Rhumatologie, Hôpital Henri Mondor, Créteil, Île-de-France, France
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, Île-de-France, France
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Chen AG, Sogbein OA, McClure JA, Reid J, Welk B, Lanting BA, Degen RM. Total Hip Arthroplasty in Patients Aged 40 to 60 years old: A Population-Based Study. J Arthroplasty 2023:S0883-5403(23)00383-2. [PMID: 37100095 DOI: 10.1016/j.arth.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION Contemporary total hip arthroplasty (THA) has resolved many implant longevity concerns in younger patients. Patients in their fourth and fifth decades of life are projected to be the fastest growing demographic of THA patients. We aimed to assess this demographic to evaluate the: 1) rate of THA over time; 2) cumulative incidence of revision; and 3) identify risk factors for revision. METHODS A retrospective population-based study of patients between 40 and 60 years old undergoing primary THA was conducted using administrative data from a large clinical data repository. A total of 28,414 patients were included for analysis with a mean age of 53 years (range, 40-60 years) and median follow up of 9 years (range, 0-17 years). Linear regressions were used to assess annual rates of THA in this cohort over time. Kaplan-Meier analysis was used to determine cumulative incidence of revision. Multivariate cox proportional hazards models were used to determine association of variables with revision risk. RESULTS The annual rate of THA in our population increased by 60.7% over the study period (P <0.0001). Cumulative incidence of revision was 2.9% at 5-years and 4.8% at 10-years. Younger age, women, non-osteoarthritis diagnosis, medical complications, and annual surgeon volume < 60 THA were associated with increased revision risk. CONCLUSION Demand for THA continues to dramatically increase in this cohort. Risk of revision was low but multiple risk factors were identified. Future studies will help delineate the effect of these variables on revision risk and assess implant survivorship beyond 10 years.
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Affiliation(s)
- Aaron G Chen
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Olawale A Sogbein
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - J Andrew McClure
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Reid
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Blayne Welk
- Institute for Clinical Evaluative Sciences (ICES), Western, London, Ontario, Canada; Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Healthcare, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Ryan M Degen
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
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Sobue Y, Kojima M, Kojima T, Ito H, Nishida K, Matsushita I, Hirata S, Kaneko Y, Kishimoto M, Kohno M, Murashima A, Morinobu A, Mori M, Nakayama T, Sugihara T, Seto Y, Tanaka E, Hasegawa M, Kawahito Y, Harigai M. Patient satisfaction with total joint replacement surgery for rheumatoid arthritis: a questionnaire survey for the 2020 update of the Japan college of rheumatology clinical practice guidelines. Mod Rheumatol 2022; 32:121-126. [PMID: 33617382 DOI: 10.1080/14397595.2021.1892258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to evaluate satisfaction with total joint replacement (TJR) surgery among patients with rheumatoid arthritis (RA). METHODS We mailed questionnaires to randomly selected members of the Japan Rheumatism Friendship Association, stratified by age and prefecture, throughout Japan. The questionnaire collected demographic and clinical characteristics as well as patients' satisfaction with TJR and their current therapy. RESULTS Of the 1156 patients who returned the questionnaire, 339 (29.3%) responded that they had had TJR of any type. The mean age was 66.6 years, and 94.4% were women. The mean time period from the hip and knee TJR was 14-15 years. Over half of the patients who had had TJR were satisfied with the results, especially those who had had hip (89.6%) and knee TJR (87.3%), who reported a high level of satisfaction. Multivariable linear regression analysis revealed that, in patients with knee TJR, satisfaction with current therapy was significantly related to whether they were satisfied with the results of the surgery. CONCLUSION Most patients with RA who had undergone TJR were satisfied with the results even after a long period of time, and their level of satisfaction was associated with their satisfaction with current therapy.
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Affiliation(s)
- Yasumori Sobue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiromu Ito
- Department of Advanced Medicine for Rheumatic Diseases and Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keiichiro Nishida
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Isao Matsushita
- Department of Rehabilitation Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Masataka Kohno
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuko Murashima
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine/Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yohei Seto
- Department of Rheumatology, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Eiichi Tanaka
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Mieko Hasegawa
- The Japan Rheumatism Friendship Association, Tokyo, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Nakajima A, Sakai R, Inoue E, Harigai M. Prevalence of patients with rheumatoid arthritis and age-stratified trends in clinical characteristics and treatment, based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Int J Rheum Dis 2020; 23:1676-1684. [PMID: 33016574 DOI: 10.1111/1756-185x.13974] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/18/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
AIM To estimate the prevalence and age-stratified treatment trends and clinical characteristics of rheumatoid arthritis (RA) in Japan. METHOD Using 7 RA definitions, the prevalence of RA in those aged ≥16 years was estimated using the National Database of Health Insurance Claims and Specific Health Checkups of Japan in the fiscal year 2017. We analyzed age-stratified trends in characteristics and treatments. RESULTS Of 1 116 122 patients aged ≥16 years with at least 1 RA-related International Classification of Diseases-10 code, 825.7 thousand patients (women, 76.3%) were assessed as having RA with an estimated prevalence of 0.65%. The highest age-stratified prevalence was 1.63% in patients aged 70-79 years. Overall, 60.8% and 7.0% of patients with RA were aged ≥65 years and ≥85 years, respectively. Methotrexate use was most frequent in patients aged 50-59 years (73.0%) and least frequent in patients aged ≥85 years (38.2%). Biologic disease-modifying antirheumatic drugs use was 50.9% in patients aged 16-19 years and decreased to 13.7% in those aged ≥85 years. Preference for the use of tumor necrosis factor inhibitors versus abatacept decreased from 24.0:1 to 1.7:1 in patients aged 16-19 years and ≥85 years, respectively. The prevalence of cardiovascular disease was 3.5% in patients aged 60-69 years and 12.1% in those aged ≥85 years. Overall RA-related orthopedic surgeries were most prevalent in patients aged 70-79 years. CONCLUSION The estimated prevalence of patients with RA in Japan was 0.65%. Age-stratified treatment trends and clinical characteristics have been described in a super-aged society for the first time.
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Affiliation(s)
- Ayako Nakajima
- Center for Rheumatic Diseases, Mie University Hospital, Tsu, Japan.,Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ryoko Sakai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Division of Multidisciplinary Management of Rheumatic Diseases, Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Research Administration Center, Showa University, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Asai S, Takemoto T, Takahashi N, Oguchi T, Ishiguro N, Kojima T. Fifteen-year trends in the number and age of patients with rheumatoid arthritis undergoing total knee and hip arthroplasty: A comparison study with osteoarthritis. Mod Rheumatol 2020; 31:768-771. [PMID: 32815447 DOI: 10.1080/14397595.2020.1812794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Shuji Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toki Takemoto
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Nobunori Takahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Oguchi
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Asai S, Takahashi N, Asai N, Yamashita S, Terabe K, Matsumoto T, Sobue Y, Nishiume T, Suzuki M, Ishiguro N, Kojima T. Characteristics of patients with rheumatoid arthritis undergoing primary total joint replacement: A 14-year trend analysis (2004–2017). Mod Rheumatol 2019; 30:657-663. [DOI: 10.1080/14397595.2019.1649111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Shuji Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobunori Takahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Kenya Terabe
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Matsumoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasumori Sobue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Nishiume
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mochihito Suzuki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ito H, Tsuji S, Nakayama M, Mochida Y, Nishida K, Ishikawa H, Kojima T, Matsumoto T, Kubota A, Mochizuki T, Sakuraba K, Matsushita I, Nakajima A, Hara R, Haraguchi A, Matsubara T, Kanbe K, Nakagawa N, Hamaguchi M, Momohara S. Does Abatacept Increase Postoperative Adverse Events in Rheumatoid Arthritis Compared with Conventional Synthetic Disease-modifying Drugs? J Rheumatol 2019; 47:502-509. [DOI: 10.3899/jrheum.181100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/18/2022]
Abstract
Objective.To investigate whether abatacept (ABA) causes more adverse events (AE) than conventional synthetic disease-modifying antirheumatic drugs (csDMARD) after orthopedic surgery in patients with rheumatoid arthritis (RA).Methods.A retrospective multicenter nested case–control study was performed in 18 institutions. Patients receiving ABA (ABA group) were matched individually with patients receiving csDMARD and/or steroids (control group). Postoperative AE included surgical site infection, delayed wound healing, deep vein thrombosis or pulmonary embolism, flare, and death. The incidence rates of the AE in both groups were compared with the Mantel-Haenszel test. Risk factors for AE were analyzed by logistic regression model.Results.A total of 3358 cases were collected. After inclusion and exclusion, 2651 patients were selected for matching, and 194 patients in 97 pairs were chosen for subsequent comparative analyses between the ABA and control groups. No between-group differences were detected in the incidence rates of each AE or in the incidence rates of total AE (control vs ABA: 15.5% vs 20.7% in total, 5.2% vs 3.1% in death).Conclusion.Compared with csDMARD and/or steroids without ABA, adding ABA to the treatment does not appear to increase the incidence rates of postoperative AE in patients with RA undergoing orthopedic surgery. Large cohort studies should be performed to add evidence for the perioperative safety profile of ABA.
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Morita O, Miura K, Hirano T, Watanabe K, Hanyu T, Netsu T, Kondo N, Fujisawa J, Saeki T, Ito T, Shobugawa Y, Yoshida K, Endo N. Changes in the incidence of cervical lesions owing to the development of rheumatoid arthritis treatment and the impact of cervical lesions on patients' quality of life. Mod Rheumatol 2019; 30:495-501. [PMID: 31116054 DOI: 10.1080/14397595.2019.1621428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To clarify changes in the incidence of cervical lesions in rheumatoid arthritis (RA) patients with advanced treatment and the impact of cervical lesions on the patients' quality of life (QOL).Methods: Incidence of radiographic cervical lesions in 1333 RA patients in 2015 was compared with that in our 1999 survey. The association between cervical lesions and QOL evaluated using three different patient-based questionnaires was also analyzed.Results: The incidence of atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS) in 2015 decreased by 50%, 75%, and 5%, respectively, compared to the 1999 survey. Although QOL, evaluated using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ; specific to myelopathy), deteriorated as the cervical lesion progressed, there was no association between cervical lesion progression and QOL evaluated using the Short Form-8™ (SF-8™; comprehensive health-related QOL). Cervical lesion progression was also associated with QOL deterioration evaluated using the Health Assessment Questionnaire Disability Index (HAQ-DI; specific to RA), but age and disease duration had stronger influences.Conclusion: The incidence of cervical lesions decreased in 2015 compared to 1999. Cervical lesion progression may be associated with QOL deterioration due to myelopathy. Age and disease duration have more impact on disease-specific QOL.
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Affiliation(s)
- Osamu Morita
- Department of Spine Surgery, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Kazuto Miura
- Department of Spine Surgery, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tadamasa Hanyu
- Department of Rheumatology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Takahiro Netsu
- Department of Rheumatology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Naoki Kondo
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Junichi Fujisawa
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takako Saeki
- Department of Rheumatology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Tomoyuki Ito
- Department of Rheumatology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Yugo Shobugawa
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kei Yoshida
- Department of Orthopedic Surgery, Toyosaka Hospital, Niigata, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
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Nystad TW, Fenstad AM, Furnes O, Fevang BT. Predictors for orthopaedic surgery in patients with rheumatoid arthritis: results from a retrospective cohort study of 1010 patients diagnosed from 1972 to 2009 and followed up until 2015. Scand J Rheumatol 2018; 47:282-290. [PMID: 29447542 DOI: 10.1080/03009742.2017.1397188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate how patient characteristics, time of diagnosis, and treatment affect the need for orthopaedic surgery in patients with rheumatoid arthritis (RA). METHOD We reviewed the medical history of 1544 patients diagnosed with RA at Haukeland University Hospital in Bergen, Norway, from 1972 to 2009, of whom 1010 (mean age 57 years, 69% women) were included in the present study. Relevant orthopaedic procedures were obtained from the Norwegian Arthoplasty Register and the hospital's administrative patient records. In total, 693 procedures (joint synovectomies 22%, arthrodeses 21%, prostheses 41%, and forefoot procedures 12%) were performed in 315 patients. Survival analyses were completed to evaluate the impact of different factors such as age, gender, radiographic changes, and year of diagnosis, on the risk of undergoing surgery. RESULTS Patients diagnosed in 1972-1985 and 1986-1998 had a relative risk of undergoing surgery of 2.4 and 2.2 (p < 0.001), respectively, compared to patients diagnosed in 1999-2009. Radiographic changes at diagnosis and female gender were also significant risk factors. Anti-rheumatic medication was significantly different in the three time periods. CONCLUSION Patients with a diagnosis in the early years had a greatly increased risk of having orthopaedic surgery performed. This is probably due to the year of diagnosis being a proxy for the type and intensity of medical treatment.
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Affiliation(s)
- T W Nystad
- a Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology , Haukeland University Hospital , Bergen , Norway.,b The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen , Norway
| | - A M Fenstad
- b The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen , Norway
| | - O Furnes
- b The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Medicine (K1) , University of Bergen , Bergen , Norway
| | - B T Fevang
- a Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology , Haukeland University Hospital , Bergen , Norway.,b The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen , Norway.,d Department of Clinical Sciences (K2) , University of Bergen , Bergen , Norway
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Goodman SM. Rheumatoid Arthritis Therapy and Joint-replacement Surgery: Are We Making a Difference? J Rheumatol 2018; 43:833-5. [PMID: 27134264 DOI: 10.3899/jrheum.160043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Susan M Goodman
- Associate Professor of Clinical Medicine, Weill Cornell Medicine College, Associate Attending Physician, Department of Rheumatology, Hospital for Special Surgery, New York, New York, USA.
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Kostuj T, Rehart S, Matta-Hurtado R, Biehl C, Willburger RE, Schmidt K. Pilot study for the registry of complications in rheumatic diseases from the German Society of Surgery (DGORh): evaluation of methods and data from the first 1000 patients. BMJ Open 2017; 7:e015987. [PMID: 29018066 PMCID: PMC5640080 DOI: 10.1136/bmjopen-2017-015987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Most patients suffering with rheumatic diseases who undergo surgical treatment are receiving immune-modulating therapy. To determine whether these medications affect their outcomes a national registry was established in Germany by the German Society of Surgery (DGORh). Data from the first 1000 patients were used in a pilot study to identify relevant corisk factors and to determine whether such a registry is suitable for developing accurate and relevant recommendations. DESIGN AND PARTICIPANTS Data were collected from patients undergoing surgical treatments with their written consent. A second consent form was used, if complications occurred. During this pilot study, in order to obtain a quicker overview, risk factors were considered only in patients with complications. Only descriptive statistical analysis was employed in this pilot study due to limited number of observed complications and inhomogeneous data regarding the surgery and the medications the patients received. Analytical statistics will be performed to confirm the results in a future outcome study. RESULTS Complications occurred in 26 patients and were distributed equally among the different types of surgeries. Twenty one of these patients were receiving immune-modulating therapy at the time, while five were not. Infections were observed in 2.3% of patients receiving and in 5.1% not receiving immunosuppression. CONCLUSIONS Due to the low number of cases, inhomogeneity in the diseases and the treatments received by the patients in this pilot study, it is not possible to develop standardised best-practice recommendations to optimise their care. Based on this observation we conclude that in order to be suitable to develop accurate and relevant recommendations a national registry must include the most important and relevant variables that impact the care and outcomes of these patients.
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Affiliation(s)
- Tanja Kostuj
- Department of Orthopedics and Traumatology, Catholic Hospital Bochum, St. Josefs Hospital, University Hospital of Ruhr University Bochum, Bochum, Germany
- Institute for Medical Biometry and Epidemiology, University of Witten/Herdecke, Witten, Germany
| | - Stefan Rehart
- Clinic for Orthopedics and Traumatology, Agaplesion Markus Hospital, Teaching Hospital of Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Ronald Matta-Hurtado
- Department of Orthopedics, Rheumatic Orthopedics and Traumatology Clinic, Catholic Hospital, Dortmund, Germany
| | - Christoph Biehl
- Department of Orthopedics, Rheumatic Orthopedics and Traumatology Clinic, Catholic Hospital, Dortmund, Germany
- Orthopedic and Rheumaorthopedic Clinic-Diakonie Hospital, Bad-Kreuznach, Germany
| | - Roland E Willburger
- Department of Rheumatic Orthopedics, Catholic Hospital Bochum, St. Elisabeth Hospital, University Hospital of Ruhr University Bochum, Bochum, Germany
| | - Klaus Schmidt
- Department of Orthopedics, Rheumatic Orthopedics and Traumatology Clinic, Catholic Hospital, Dortmund, Germany
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Chen YC, Chiu WC, Cheng TT, Lai HM, Yu SF, Su BYJ, Hsu CY, Ko CH, Chen JF. Delayed anti-TNF therapy increases the risk of total knee replacement in patients with severe rheumatoid arthritis. BMC Musculoskelet Disord 2017; 18:326. [PMID: 28764690 PMCID: PMC5540514 DOI: 10.1186/s12891-017-1685-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 07/17/2017] [Indexed: 11/17/2022] Open
Abstract
Background This study evaluated the effect of early anti-tumor necrosis factor (TNF) therapy in patients with severe rheumatoid arthritis (RA) on the subsequent risk of total knee replacement (TKR) surgery. Methods This retrospective observational study included a hospital-based cohort of 200 patients diagnosed with severe RA who received treatment with anti-TNF therapy between 2003 and 2014. Clinical parameters including age, sex, body mass index, and the time from the diagnosis of RA to the initiation of anti-TNF therapy were analyzed. Results Of the 200 enrolled patients, 84 underwent an early intervention (≤3 years from the diagnosis of RA to the initiation of anti-TNF therapy), and 116 underwent a late intervention(>3 years from the diagnosis of RA to the initiation of anti-TNF therapy). Five (6.0%) patients in the early intervention group underwent TKR compared to 31 (26.7%) in the late intervention group (p = 0.023). After adjusting for confounding factors, the late intervention group still had a significantly higher risk of TKR (p = 0.004; odds ratio, 5.572; 95% confidence interval, 1.933–16.062). Those receiving treatment including methotrexate had a lower risk of TKR (p = 0.004; odds ratio, 0.287; 95% confidence interval, 0.122–0.672). Conclusions Delayed initiation of anti-TNF therapy in the treatment of severe RA was associated with an increased risk of TKR surgery. Adding methotrexate treatment decreased the risk of future TKR.
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Affiliation(s)
- Ying-Chou Chen
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan.
| | - Wen-Chan Chiu
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Tien-Tsai Cheng
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Han-Ming Lai
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Shan-Fu Yu
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Ben Yu-Jih Su
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Chung-Yuan Hsu
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Chi-Hua Ko
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
| | - Jia-Feng Chen
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, Kaohsiung, 833, Taiwan
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Bansback N, Fu E, Sun H, Guh D, Zhang W, Lacaille D, Milbers K, Anis AH. Do Biologic Therapies for Rheumatoid Arthritis Offset Treatment-Related Resource Utilization and Cost? A Review of the Literature and an Instrumental Variable Analysis. Curr Rheumatol Rep 2017; 19:54. [DOI: 10.1007/s11926-017-0680-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Coûts d’utilisation des services de soins de santé imputables à la polyarthrite rhumatoïde en France : analyse d’une base de données représentative nationale. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.rhum.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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15
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Healthcare service utilisation costs attributable to rheumatoid arthritis in France: Analysis of a representative national claims database. Joint Bone Spine 2016; 83:53-6. [DOI: 10.1016/j.jbspin.2015.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 02/17/2015] [Indexed: 02/04/2023]
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Asai S, Kojima T, Oguchi T, Kaneko A, Hirano Y, Yabe Y, Kanayama Y, Takahashi N, Funahashi K, Hanabayashi M, Hirabara S, Yoshioka Y, Takemoto T, Terabe K, Asai N, Ishiguro N. Effects of Concomitant Methotrexate on Large Joint Replacement in Patients With Rheumatoid Arthritis Treated With Tumor Necrosis Factor Inhibitors: A Multicenter Retrospective Cohort Study in Japan. Arthritis Care Res (Hoboken) 2015; 67:1363-70. [PMID: 25832554 DOI: 10.1002/acr.22596] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 02/19/2015] [Accepted: 03/24/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the effects of concomitant methotrexate (MTX) on the incidence of large joint replacement resulting from the progression of large joint destruction in patients with rheumatoid arthritis (RA) treated with tumor necrosis factor (TNF) inhibitors. METHODS A retrospective cohort study was performed using a multicenter registry. In total, 803 patients with RA who received etanercept or adalimumab were included. The first large joint replacement during treatment with etanercept or adalimumab was used as the outcome variable in predictive analyses. The cumulative incidence of large joint replacement was estimated using Kaplan-Meier curves, and the impact of concomitant MTX on the incidence of large joint replacement was assessed with Cox proportional hazards models. Propensity score matching was used to reduce selection bias. RESULTS Of all patients, 601 (75%) received concomitant MTX at a median dosage of 8 mg/week (interquartile range 6-8). A total of 49 patients (62 joints) underwent large joint replacement during treatment with etanercept or adalimumab. The incidence of large joint replacement for patients with concomitant MTX was significantly lower than that for patients without MTX (P < 0.001). Multivariate analysis revealed that concomitant MTX independently predicted large joint replacement (hazard ratio 0.36, 95% confidence interval 0.20-0.65). Additionally, propensity score-matched analysis demonstrated that patients with concomitant MTX had a significantly lower incidence of large joint replacement than those without concomitant MTX (P = 0.032). CONCLUSION Concomitant MTX reduces the incidence of large joint replacement in patients with RA treated with TNF inhibitors.
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Affiliation(s)
- Shuji Asai
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | | | - Yuji Hirano
- Toyohashi Municipal Hospital, Toyohashi, Japan
| | | | | | | | - Koji Funahashi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Yutaka Yoshioka
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toki Takemoto
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenya Terabe
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Asai
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Nagoya University Graduate School of Medicine, Nagoya, Japan
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Dusad A, Pedro S, Mikuls TR, Hartman CW, Garvin KL, O'Dell JR, Michaud K. Impact of Total Knee Arthroplasty as Assessed Using Patient-Reported Pain and Health-Related Quality of Life Indices: Rheumatoid Arthritis Versus Osteoarthritis. Arthritis Rheumatol 2015. [DOI: 10.1002/art.39221] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Anand Dusad
- Veterans Affairs Nebraska−Western Iowa Health Care System and University of Nebraska Medical Center; Omaha
| | - Sofia Pedro
- National Data Bank for Rheumatic Diseases; Wichita Kansas
| | - Ted R. Mikuls
- Veterans Affairs Nebraska−Western Iowa Health Care System and University of Nebraska Medical Center; Omaha
| | | | | | - James R. O'Dell
- Veterans Affairs Nebraska−Western Iowa Health Care System and University of Nebraska Medical Center; Omaha
| | - Kaleb Michaud
- National Data Bank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center; Omaha
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Nystad TW, Fenstad AM, Furnes O, Havelin LI, Skredderstuen AK, Fevang BTS. Reduction in orthopaedic surgery in patients with rheumatoid arthritis: a Norwegian register-based study. Scand J Rheumatol 2015; 45:1-7. [DOI: 10.3109/03009742.2015.1050451] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Tornero-Molina J. Clinical repercussions of introducing biological therapies: the well-controlled patient. ACTA ACUST UNITED AC 2015; 11:131-2. [PMID: 25769793 DOI: 10.1016/j.reuma.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 01/25/2015] [Accepted: 01/31/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Jesús Tornero-Molina
- Sección de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, España; Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
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Affiliation(s)
- C Fontaine
- Service de chirurgie de la main et du membre supérieur, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU, rue du Pr-Émile-Laine, 59037 Lille cedex, France.
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Ochi K, Iwamoto T, Saito A, Ikari K, Toyama Y, Taniguchi A, Yamanaka H, Momohara S. Construct validity, reliability, response rate, and association with disease activity of the quick disabilities of the arm, shoulder and hand questionnaire in the assessment of rheumatoid arthritis. Mod Rheumatol 2014; 25:241-5. [DOI: 10.3109/14397595.2014.939420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Recommendations of the French Society for Rheumatology for managing rheumatoid arthritis. Joint Bone Spine 2014; 81:287-97. [DOI: 10.1016/j.jbspin.2014.05.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 11/21/2022]
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Gaujoux-Viala C, Gossec L, Cantagrel A, Dougados M, Fautrel B, Mariette X, Nataf H, Saraux A, Trope S, Combe B. Recommandations de la Société française de rhumatologie pour la prise en charge de la polyarthrite rhumatoïde. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rhum.2014.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
STUDY DESIGN Retrospective data analysis. OBJECTIVE To compare the trends in primary cervical spine fusion procedures in patients with rheumatoid arthritis (RA) against those in the general population. SUMMARY OF BACKGROUND DATA RA severely impacts multiple joints in the body and can result in substantial deformity and functional impairment. Cervical spine involvement is common. In the past decade, treatment for RA has changed substantially with the introduction of biologically based, disease-modifying antirheumatic medications. Recent literature has shown decreasing rates of total joint arthroplasty in patients with RA. METHODS Cases of cervical spine fusion in the general population and in patients with RA were identified from the Nationwide Inpatient Sample from 1992 through 2008. US population counts were obtained from the Census Bureau. Data were analyzed with computer software (significance, P < 0.05 for all analyses). Linear regression models were used to describe national rates of cervical spine fusion in patients with and without RA. RESULTS There was a marked increase in the number of cervical fusion procedures in the studied population. Over time, the incidence of atlantoaxial fusion increased in the general population (P < 0.01) and decreased in patients with RA (P < 0.01). Compared with the general population, patients with RA had a significantly lower rate of increase in the incidence of posterior cervical fusion (P < 0.01) and a significantly higher rate of increase in the incidence of anterior cervical fusion (P < 0.01). CONCLUSION In the US, the absolute number of primary cervical fusion procedures from 1992 through 2008 increased in the general population and in patients with RA. However, the patients with RA had a significantly lower incidence of undergoing atlantoaxial and posterior cervical surgical procedures than did the general population. LEVEL OF EVIDENCE 2.
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Momohara S, Inoue E, Ikari K, Ochi K, Ishida O, Yano K, Sakuma Y, Yoshida S, Koyama T, Koenuma N, Taniguchi A, Yamanaka H. Recent trends in orthopedic surgery aiming to improve quality of life for those with rheumatoid arthritis: data from a large observational cohort. J Rheumatol 2014; 41:862-6. [PMID: 24692532 DOI: 10.3899/jrheum.131018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe current trends in the numbers of rheumatoid arthritis (RA)-related surgeries. METHODS The number of operations was determined for patients with RA in a large observational cohort [Institute of Rheumatology, Rheumatoid Arthritis (IORRA)] enrolled from 2001 to 2012. RESULTS The total number of operations peaked in 2002 and gradually decreased thereafter, but began to increase again in 2008. The number of total knee replacements has decreased since 2003, while the number of wrist and foot arthroplasties and the number of artificial finger prosthesis surgeries have increased gradually. CONCLUSION Our results suggest that the number of orthopedic surgeries may change in response to changes in the drug therapy for RA.
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Affiliation(s)
- Shigeki Momohara
- From the Institute of Rheumatology, Tokyo Women's Medical University, Shinjuku, Tokyo, 162-0054, Japan
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Momohara S, Tanaka S, Nakamura H, Mibe J, Iwamoto T, Ikari K, Nishino J, Kadono Y, Yasui T, Takahashi K, Takenouchi K, Hashizume K, Nakahara R, Kubota A, Nakamura T, Nishida K, Suguro T. Recent trends in orthopedic surgery performed in Japan for rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0426-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yamagiwa K, Iijima S, Furuya T, Ikai T, Inoue E, Taniguchi A, Momohara S, Yamanaka H. Incidence of falls and fear of falling in Japanese patients with rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0351-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Yano K, Ikari K, Inoue E, Tokita A, Sakuma Y, Hiroshima R, Iwamoto T, Kawakami K, Taniguchi A, Yamanaka H, Momohara S. Effect of total knee arthroplasty on disease activity in patients with established rheumatoid arthritis: 3-year follow-up results of combined medical therapy and surgical intervention. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0309-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Momohara S, Inoue E, Ikari K, Yano K, Tokita A, Suzuki T, Sakuma Y, Hiroshima R, Kawakami K, Masuda I, Iwamoto T, Taniguchi A, Yamanaka H. Efficacy of total joint arthroplasty in patients with established rheumatoid arthritis: improved longitudinal effects on disease activity but not on health-related quality of life. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0432-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shigeki Momohara
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Eisuke Inoue
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Katsunori Ikari
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Koichiro Yano
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Asami Tokita
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Yu Sakuma
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Ryo Hiroshima
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Kosei Kawakami
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Ikuko Masuda
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Atsuo Taniguchi
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
| | - Hisashi Yamanaka
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan
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Tanaka E, Hoshi D, Igarashi A, Inoue E, Shidara K, Sugimoto N, Sato E, Seto Y, Nakajima A, Momohara S, Taniguchi A, Tsutani K, Yamanaka H. Analysis of direct medical and nonmedical costs for care of rheumatoid arthritis patients using the large cohort database, IORRA. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0729-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Momohara S, Inoue E, Ikari K, Yano K, Tokita A, Honjo Y, Sakuma Y, Hiroshima R, Iwamoto T, Seto Y, Tanaka E, Taniguchi A, Yamanaka H. Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0495-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Seto Y, Tanaka E, Inoue E, Nakajima A, Taniguchi A, Momohara S, Yamanaka H. Studies of the efficacy and safety of methotrexate at dosages over 8 mg/week using the IORRA cohort database. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0445-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kokkonen A, Jämsen E, Belt EA, Lehto MUK. Incidence of rheumatoid arthritis-related ankle replacement and ankle arthrodesis: a Finnish nationwide register-based study from 1997–2010. Acta Orthop 2013; 84:338-41. [PMID: 23992138 PMCID: PMC3768030 DOI: 10.3109/17453674.2013.831319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/03/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE For 20 years, medical treatment of rheumatoid arthritis (RA) has been improving and the incidence of joint surgery has decreased. We investigated the rates of primary ankle joint arthrodesis and total ankle arthroplasty in patients with RA in Finland between 1997 and 2010 to establish whether trends have changed during that period. METHODS The annual figures for primary ankle joint arthrodeses and total ankle replacements performed in patients with RA were obtained from nationwide population-based registries. Incidences were calculated per population of 10(5) and they are reported in 2-year periods. RESULTS During the study period, 593 primary ankle joint arthrodeses and 318 total ankle arthroplasties were performed in patients with RA. The incidence of ankle joint arthrodesis reached its highest value (2.4/10(5)) in 1997-1998 and it was lowest in 2001-2002 (1.1/10(5)). After 2002, the incidence increased slightly but did not reach the level in 1997-1998, even though total ankle replacements almost ended in Finland during the period 2009-2010. From 1997, total ankle replacements increased until 2003-2004 (incidence 1.5/10(5)) and then gradually decreased. In 2009-2010, the incidence of total ankle replacements was only 0.4/10(5). INTERPRETATION During the observation period 1997-2010, while total ankle replacements generally became more common in patients with RA, the incidence of primary ankle joint arthrodesis decreased and did not increase in the period 2009-2010, even though total ankle replacement surgery almost ended in Finland. No change in the incidence of these operations, when pooled together, was observed from 1997 to 2010.
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Affiliation(s)
- Ari Kokkonen
- Science Center of Pirkanmaa Hospital District, Tampere, Finland.
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34
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Aaltonen KJ, Virkki LM, Jämsen E, Sokka T, Konttinen YT, Peltomaa R, Tuompo R, Yli-Kerttula T, Kortelainen S, Ahokas-Tuohinto P, Blom M, Nordström DC. Do biologic drugs affect the need for and outcome of joint replacements in patients with rheumatoid arthritis? A register-based study. Semin Arthritis Rheum 2013; 43:55-62. [DOI: 10.1016/j.semarthrit.2013.01.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 11/28/2022]
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Jämsen E, Virta LJ, Hakala M, Kauppi MJ, Malmivaara A, Lehto MUK. The decline in joint replacement surgery in rheumatoid arthritis is associated with a concomitant increase in the intensity of anti-rheumatic therapy: a nationwide register-based study from 1995 through 2010. Acta Orthop 2013; 84:331-7. [PMID: 23992137 PMCID: PMC3768029 DOI: 10.3109/17453674.2013.810519] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Drug-based treatment of rheumatoid arthritis (RA) has evolved markedly over the past 2 decades. Using nationwide register data, we studied how this has affected the rates of hip, knee, shoulder, and elbow replacement from 1995 to 2010. METHODS The number of primary joint replacements was obtained from the Finnish Arthroplasty Register. To test the hypothesis that improvements in medical treatment of RA reduce the need for joint replacements, we also collected data about purchases of different disease-modifying anti-rheumatic agents (DMARDs) and biological drugs from the nationwide drug registers. RESULTS The annual incidence of primary joint replacements for RA declined from 19 per 10(5) in 1995 to 11 per 10(5) in 2010. The decline was greater for upper-limb operations than for lower-limb operations. At the same time, the numbers of individuals using methotrexate, hydroxychloroquine, and sulfasalazine (the most commonly used DMARDs) increased 2- to 4-fold. INTERPRETATION Our results are in accordance with observations from other countries, and indicate that the use of joint replacements in RA has decreased dramatically. Our data suggest that effective medical therapy is the most likely explanation for this favorable development.
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Affiliation(s)
- Esa Jämsen
- Coxa, Hospital for Joint Replacement, Tampere,School of Medicine, University of Tampere, Tampere
| | - Lauri J Virta
- Research Department, Social Insurance Institution of Finland, Turku
| | - Markku Hakala
- School of Medicine, University of Tampere, Tampere,Päijät-Häme Central Hospital, Lahti
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Wakabayashi H, Hasegawa M, Yoshida K, Nishioka K, Sudo A. Hip score and disease activity correlation in patients with rheumatoid arthritis after total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2013; 37:1245-50. [PMID: 23640680 DOI: 10.1007/s00264-013-1900-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 04/14/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The disease activity score including 28 joints (DAS28), the simplified disease activity index and the clinical disease activity index (CDAI) were developed in order to provide a quantifiable measure of rheumatoid arthritis (RA) activity. Although inflamed hip joints greatly impact activities of daily living (ADL) and walking ability, the hip joint was not included in the DAS28, SDAI or CDAI assessments. Although excellent clinical results have been reported for total hip arthroplasty (THA) in RA patients, correlations between disease activity and hip function in RA patients after THA remain unknown. METHODS We analysed the effect of RA disease activity on a hip function score in an observational cohort of RA patients after THA. Twenty-five registered RA patients who had undergone THA (33 joints) were included. Hip function was recorded and RA disease activity was measured on the same day. The mean age of the patients was 65.17 years. They were followed up for a mean of 5.24 years after surgery. The mean duration of disease following RA diagnosis for this patient group was 19.47 years. The Japanese Orthopaedic Association (JOA) hip score was used as a clinical outcome measure for hip dysfunction. RA disease activity and health-related quality of life were measured using the DAS28, SDAI, CDAI and the modified health assessment questionnaire (MHAQ). RESULTS The mean JOA score for hip function was 80.48 at the final follow-up. The mean DAS28-ESR, DAS28-CRP, SDAI, CDAI and MHAQ measuring RA disease activity levels were 3.38, 2.65, 9.59, 8.63 and 0.44, respectively, at the final follow-up. There was a significant negative correlation between the JOA hip score and all disease activity assessments observed after THA (DAS-ESR [P = 0.0067], DAS-CRP [P = 0.0008]), SDAI [P = 0.0034], CDAI [P = 0.0003]) and MHAQ [P = 0.0002]). CONCLUSION We found significant negative correlations between JOA hip scores and all disease activity assessments in RA patients treated with THA.
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Affiliation(s)
- Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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Furuya T, Inoue E, Hosoi T, Taniguchi A, Momohara S, Yamanaka H. Risk factors associated with the occurrence of hip fracture in Japanese patients with rheumatoid arthritis: a prospective observational cohort study. Osteoporos Int 2013; 24:1257-65. [PMID: 22801953 DOI: 10.1007/s00198-012-2080-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 07/02/2012] [Indexed: 12/17/2022]
Abstract
UNLABELLED Risk factors associated with the occurrence of hip fracture in Japanese patients with rheumatoid arthritis (RA) were evaluated in a prospective, observational cohort study. Physical disability, advanced age, history of total knee replacement (TKR), and low body mass index (BMI) appear to be associated with the occurrence of hip fracture. INTRODUCTION This study seeks to evaluate the association between potential risk factors and the occurrence of hip fractures in Japanese RA patients. METHODS A total of 9,720 patients (82.1% female; mean age, 55.7 years) with RA were enrolled in a prospective observational study from 2000 to 2010. Self-reported hip fractures were verified using patient medical records. Cox proportional hazards models were used to analyze independent contributions of various risk factors to hip fracture occurrence. RESULTS During a mean follow-up of 5.2 years, 152 patients reported 152 hip fractures. Among these patients, 97 hip fractures in 97 patients (15 males, 82 females) were verified with medical records. Japanese version of the Health Assessment Questionnaire (J-HAQ) disability score [per 1 score, hazard ratio (HR), 2.64; 95% confidence interval (CI), 1.94-3.58], age (per 10 years; HR, 1.53; 95% CI, 1.25-1.87), history of TKR (HR, 3.75; 95% CI, 1.57-8.96), and BMI (per 1 kg/m2, HR, 0.92; 95% CI, 0.86-0.99) were significantly associated with hip fractures. Among the scores on the eight domains of the J-HAQ, J-HAQ (arising) (HR, 1.74; 95% CI, 1.28-2.36) and J-HAQ (hygiene) (HR, 1.58; 95% CI, 1.11-2.24) were significantly correlated with the occurrence of hip fracture. CONCLUSIONS High J-HAQ disability score, advanced age, history of TKR, and low BMI appear to be associated with the occurrence of hip fractures in Japanese RA patients. Among the eight domains of the J-HAQ, arising and hygiene disabilities appear to be correlated with the occurrence of hip fractures in this patient population.
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Affiliation(s)
- T Furuya
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
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Aspects médico-économiques de la polyarthrite rhumatoïde. BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2012. [DOI: 10.1016/s0001-4079(19)31711-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fautrel B. Economic benefits of optimizing anchor therapy for rheumatoid arthritis. Rheumatology (Oxford) 2012; 51 Suppl 4:iv21-6. [PMID: 22685272 DOI: 10.1093/rheumatology/kes088] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The total cost of RA is substantial, particularly in patients with high levels of disability. There are considerable differences in cost between countries, driven in part by differences in the use of biologic therapies. Economic evaluations are needed to assess the extra cost of using these treatments and the benefits obtained, to ensure appropriate allocation of limited health care resources. The BeSt trial, evaluating four treatment strategies, found comparable medium-term efficacy but substantially higher costs with early biologic therapy. A systematic review of such cost-effectiveness analyses concluded that biologic therapy should be used after therapy has failed with less costly alternatives such as synthetic DMARDs and glucocorticoids. Optimizing such relatively low-cost therapy to improve outcomes may delay the need for biologic therapy, thereby saving costs. A simple model has confirmed the value of this approach. The addition of modified-release prednisone 5 mg/day to existing synthetic DMARD therapy in patients with active disease resulted in improvement in DAS-28 to below the threshold level for initiation of reimbursed biologic therapy in 28-34% of patients. On a conservative estimate (i.e. assuming no further benefits beyond the 12 weeks of the study and a 12-week wait-and-see approach to starting biologic therapy), cost savings amounted to nearly € 400 per patient. While treatment decisions should never be based only on cost considerations, prolonging disease control by optimizing the use of non-biologic treatments may bring benefits to patients and also economic benefits by delaying the need for biologic treatments.
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Affiliation(s)
- Bruno Fautrel
- Department of Rheumatology, University of Pierre and Marie Curie - Paris 6, AP-HP, Pitie Salpetrière University Hospital, 83 Boulevard de l'Hôpital, 75013 Paris, France.
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Tanaka E, Hoshi D, Igarashi A, Inoue E, Shidara K, Sugimoto N, Sato E, Seto Y, Nakajima A, Momohara S, Taniguchi A, Tsutani K, Yamanaka H. Analysis of direct medical and nonmedical costs for care of rheumatoid arthritis patients using the large cohort database, IORRA. Mod Rheumatol 2012; 23:742-51. [PMID: 22878927 DOI: 10.1007/s10165-012-0729-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/17/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Our goal was to determine the annual direct medical and nonmedical costs for the care of patients with rheumatoid arthritis (RA) using data from a large cohort database in Japan. METHODS Direct medical costs [out of pocket to hospitals and pharmacies and for complementary and alternative medicine (CAM)] and nonmedical costs (caregiving, transportation, self-help devices, house modifications) were determined for RA patients who were participants in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) studies conducted in October 2007 and April 2008. Correlations between these costs and RA disease activity, disability level, and quality of life (QOL) were assessed. RESULTS Data were analyzed from 5,204 and 5,265 RA patients in October 2007 and April 2008, respectively. The annual direct medical costs were JPY132,000 [out of pocket to hospital (US$1 = JPY90 in 2007)], JPY84,000 (out of pocket to pharmacy), and JPY146,000 (CAM). Annual direct nonmedical costs were JPY105,000 (caregiving), JPY22,000 (transportation), JPY30,000 (self-help devices), and JPY188,000 (house modifications). Based on the utilization rate for each cost component, the annual medical and nonmedical costs for each RA patient were JPY262,136 and JPY61,441, respectively. Costs increased with increasing RA disease activity and disability level or worsening quality of life (QOL). CONCLUSIONS Based on the IORRA database, patients with RA bear heavy economic burdens that increase as the disease is exacerbated. The results also suggest that the increase in medical and nonmedical costs may be ameliorated by the proactive control of disease activity.
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Affiliation(s)
- Eiichi Tanaka
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo 162-0054, Japan.
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Total joint arthroplasty in patients with rheumatoid arthritis: a United States experience from 1992 through 2005. J Arthroplasty 2012; 27:881-8. [PMID: 22333866 DOI: 10.1016/j.arth.2011.12.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 12/24/2011] [Indexed: 02/01/2023] Open
Abstract
To determine whether total joint arthroplasty (TJA) for patients with rheumatoid arthritis (RA) is decreasing, we collected Nationwide Inpatient Sample database information (1992 through 2005) on (1) the number of primary TJAs for all patient diagnoses, (2) the number of primary TJAs for patients with RA, and (3) distribution of age and sex in both groups. To account for population growth, a given year's arthroplasty estimate was normalized against its population. The trends over time were analyzed using a multivariable Poisson regression model (significance, P < .05). We found that the number of primary TJA procedures increased in the general and RA populations but that, after adjusting for population growth, age, and sex, the rate was significantly lower in patients with RA.
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Yamanaka H. [108th Scientific Meeting of the Japanese Society of Internal medicine: invited lecture: 5. IORRA, a large cohort study for rheumatoid arthritis in Japan]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2011; 100:2447-2463. [PMID: 22117333 DOI: 10.2169/naika.100.2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Japan
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Momohara S, Ikari K, Kawakami K, Iwamoto T, Inoue E, Yano K, Sakuma Y, Hiroshima R, Tokita A, Taniguchi A, Yamanaka H. The increasing disease duration of patients at the time of orthopaedic surgery for rheumatoid arthritis. Rheumatol Int 2011; 32:3323-4. [DOI: 10.1007/s00296-011-2101-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 08/21/2011] [Indexed: 11/29/2022]
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Economic consequences and potential benefits. Best Pract Res Clin Rheumatol 2011; 25:607-24. [DOI: 10.1016/j.berh.2011.10.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/11/2011] [Indexed: 11/21/2022]
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Momohara S, Inoue E, Ikari K, Yano K, Tokita A, Honjo Y, Sakuma Y, Hiroshima R, Iwamoto T, Seto Y, Tanaka E, Taniguchi A, Yamanaka H. Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute. Mod Rheumatol 2011; 22:209-15. [PMID: 21761229 DOI: 10.1007/s10165-011-0495-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 06/14/2011] [Indexed: 10/18/2022]
Abstract
The treatment of rheumatoid arthritis (RA) has improved dramatically with the advent of the latest generation of disease-modifying antirheumatic drugs. Despite these advances, in some patients inflammation is not diminished sufficiently to prevent irreversible musculoskeletal damage, thereby necessitating surgical intervention to reduce pain and improve function. For RA treatment, Japanese orthopedic surgeons also prescribe medication. In this study, we examined whether this Japanese system is effective for RA treatment. We analyzed the clinical condition of RA patients treated by rheumatologists and those treated by orthopedists in a linked registry study using information from a large observational cohort of RA patients followed every half year from 2000 to 2010 (the IORRA cohort). Two groups of patients were compared: patients treated by rheumatologists (rheumatologic group) and patients treated by orthopedists (orthopedic group). The results revealed that patients in the orthopedic group were older, more likely to be female, and had a longer disease duration than patients in the rheumatologic group. The proportion of patients with a history of joint surgery was also much higher in the orthopedic group than in the rheumatologic group. The average scores on the Japanese version of the Health Assessment Questionnaire, and the remission ratio determined using a Boolean-based definition gradually increased from 2000 until 2010, and these findings were consistently better in the rheumatologic group than in the orthopedic group. These data suggest that patients treated primarily by orthopedists are more likely to have long-standing RA compared to patients treated by rheumatologists. Therefore, it is critical for rheumatologists and orthopedists to complement each other medically in the treatment of RA patients.
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Affiliation(s)
- Shigeki Momohara
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan.
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Abstract
Since the mid 1980s, a global decrease in surgical procedures related to rheumatoid arthritis (RA) has been documented for joint-preserving procedures such as synovectomy as well as joint replacement surgery. This reflects improvements in the early management of rheumatoid arthritis and availability of more effective medical treatment. The present review summarizes the recent literature on the frequency of orthopaedic surgery in RA patients as well as the role of synovectomy in the rheumatoid hip, knee and shoulder in times of biological RA therapy.
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Affiliation(s)
- H-D Carl
- Abteilung für Orthopädische Rheumatologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Im Waldkrankenhaus St. Marien, Rathsberger Str. 57, 91054, Erlangen.
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Studies of the efficacy and safety of methotrexate at dosages over 8 mg/week using the IORRA cohort database. Mod Rheumatol 2011; 21:579-93. [PMID: 21424533 PMCID: PMC3236829 DOI: 10.1007/s10165-011-0445-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 03/07/2011] [Indexed: 12/19/2022]
Abstract
The maximum dosage of methotrexate (MTX) for treatment of rheumatoid arthritis (RA) formally approved in Japan is 8 mg/week. We intended to examine the efficacy and safety of MTX at dosages over 8 mg/week in Japanese rheumatoid arthritis patients using the large Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort database. Among 9,122 patients registered in the IORRA database from the October 2000 survey to the October 2007 survey, 5,201 patients who had been treated with MTX were selected. We attempted to overcome the drawbacks innate to nonrandomized studies by using longitudinal analyses and multifactorial logistic regression analyses. Cross-sectional analysis of data obtained from the October 2007 survey indicated that dosages of MTX higher than 8 mg/week were used in 27.5% of patients treated with MTX. Longitudinal analyses based on data from three consecutive phases showed that final Disease Activity Score-28 (DAS28) values were significantly lower [n = 260, mean difference 0.563, 95% confidence interval (CI) 0.438-0.688, P < 2.2 × 10(-22), two-sided paired t test] than initial values when MTX was increased from 8 mg/week or lower to over 8 mg/week. In addition, longitudinal analyses based on data from two consecutive phases indicated decreases in DAS28 values of 0.26 ± 1.04 (n = 690, P = 6.78 × 10(-11), two-sided paired t test) when MTX dosages were increased from 8 mg/week or lower to over 8 mg/week, compared with decreases of 0.07 ± 0.89 (n = 2,125, P = 0.000307) when the dosage was maintained at 8 mg/week. The decreases in DAS28 values were significantly larger in the former than the latter (P = 2.27 × 10(-6), two-sided unpaired t test). Concerning safety of MTX at dosages over 8 mg/week, we performed logistic regression analysis in which the objective variable was the existence or nonexistence of self-reported side-effects and the explanatory variable was the MTX dosage in the former phase, with adjustments made for age, sex, body mass index (BMI), steroid administration, folic acid administration, concomitant pulmonary diseases, and renal dysfunction. The results indicated that MTX dosages over 8 mg/week did not have any association with either severe or severe + moderate side-effects. These data regarding both efficacy and safety of MTX at dosages over 8 mg/week in Japanese RA patients would provide the basis for use of the drug at dosages currently not formally approved by the Japanese government.
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Efficacy of total joint arthroplasty in patients with established rheumatoid arthritis: improved longitudinal effects on disease activity but not on health-related quality of life. Mod Rheumatol 2011; 21:476-81. [PMID: 21373798 DOI: 10.1007/s10165-011-0432-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
Abstract
Though excellent clinical results have been reported for total joint arthroplasty (TJA) in rheumatoid arthritis (RA) patients, the longitudinal effects of TJA on pain, physical function, and health-related quality of life in RA patients remain unknown. This study aimed to assess changes in disease activity and health-related quality of life after TJA in patients with established RA. We analyzed the effect of total knee arthroplasty (TKA) and total hip arthroplasty (THA) on RA disease activity in an observational cohort of RA patients. Of the registered RA patients, 333 TKA and 77 THA patients were followed for 5 years after surgery. RA disease activity and health-related quality of life were measured using the Disease Activity Score 28 (DAS28) and a Japanese version of the Stanford health assessment questionnaire (J-HAQ). The mean DAS28 in TKA patients decreased from 4.66 (preoperatively) to 4.02 (3 years postoperatively) and to 3.94 (5 years postoperatively); the mean DAS28 in THA patients decreased from 4.41 (preoperatively) to 3.99 (3 years postoperatively) and to 3.92 (5 years postoperatively). The mean J-HAQ for TKA remained essentially unchanged, ranging from 1.48 (preoperatively) to 1.45 (3 years postoperatively) and to 1.47 (5 years postoperatively); the mean J-HAQ for THA also remained unchanged, ranging from 1.74 (preoperatively) to 1.74 (3 years postoperatively) and to 1.73 (5 years postoperatively). Of the total J-HAQ score, the lower limb score improved while the upper limb score worsened. Although TKA and THA improve clinical outcomes in damaged knees and hips and have a positive secondary systemic effect on RA disease activity, they have not had a continuously good effect on the measures of health-related quality of life. We conclude that tight control of RA disease activity is indicated for those patients with TKA and/or THA.
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Momohara S, Tanaka S, Nakamura H, Mibe J, Iwamoto T, Ikari K, Nishino J, Kadono Y, Yasui T, Takahashi K, Takenouchi K, Hashizume K, Nakahara R, Kubota A, Nakamura T, Nishida K, Suguro T. Recent trends in orthopedic surgery performed in Japan for rheumatoid arthritis. Mod Rheumatol 2011; 21:337-42. [PMID: 21347802 DOI: 10.1007/s10165-011-0426-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
The aim of this report was to review the use of orthopedic surgeries performed to manage rheumatoid arthritis (RA). Our review of studies published in English indicates that there has been a decrease in RA-associated surgeries in Western countries. Improvements in medical treatment may partly explain the reduction in numbers of orthopedic joint surgeries, which also suggests a worldwide trend toward improved long-term outcomes. However, the results of our multicenter study in Japan indicate that the number of RA-associated operations has not decreased, and that the numbers of operations performed annually have been relatively stable from 1998 to 2008. Although there definitely has been a decline in the numbers of synovectomy surgeries, the numbers of operations on the upper limbs and foot arthroplasties have increased. With the trend toward milder disease because of improved medical treatment, we speculate that RA patients may want and need better function for the activities of daily living. The combination of medical treatment and surgical intervention is thought to improve outcomes in RA patients who will develop joint destruction. Additional studies, including analyses of RA databases containing long-term data on a variety of surgical interventions, are needed.
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Affiliation(s)
- Shigeki Momohara
- Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada, Shinjuku, Tokyo, 162-0054, Japan.
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De Piano LPA, Golmia RP, Scheinberg MA. Decreased need of large joint replacement in patients with rheumatoid arthritis in a specialized Brazilian center. Clin Rheumatol 2010; 30:549-50. [DOI: 10.1007/s10067-010-1629-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 09/24/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
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