The impact of rheumatoid arthritis on the risk of adverse events following joint replacement : a real-world cohort study
Burn, Edward (Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK)
Edwards, Christopher J. (University Hospital Southampton NHS Foundation Trust (Regne Unit))
Murray, David W. (Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK)
Silman, Alan (Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK)
Cooper, Cyrus (MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK)
Arden, N. K (MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK)
Prieto-Alhambra, Daniel (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Pinedo-Villanueva, Rafael (MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK)
Universitat Autònoma de Barcelona

Data:	2018
Resum:	To assess whether rheumatoid arthritis (RA) is associated with a greater risk of adverse events following total knee replacement (TKR) and total hip replacement (THR) than osteoarthritis (OA). Individuals with a diagnosis of RA or OA were identified using primary care records. TKR and THR following diagnosis were identified using linked hospital records. Myocardial infarction (MI), prosthetic joint infection (PJI), venous thromboembolism (VTE), and death were identified within 90 days following surgery, and revision procedures over 10 years following surgery. The impact of RA compared to OA on the risk for these adverse events was assessed using Cox proportional hazard models. Univariable models, with diagnosis as the only explanatory variable, and multivariable models, with age, gender, and year of surgery first added and then a measure of other comorbidities also included, were estimated. In all 20,763 individuals, with 10,260 TKR and 10,961 THR, were included in the analysis. Compared to those with OA, individuals with a diagnosis of RA had a greater incidence of MI over 90 days following TKR (OA: 0. 28%, RA: 0. 75%) and revision over 10 years following THR (OA: 5. 55%, RA: 8. 68%). Both of these differences were statistically significant with, for example, hazard ratios of 3. 54 (1. 44 to 8. 73) for MI and 1. 61 (1. 06 to 2. 46) for revision after controlling for age, gender, year of surgery, and other comorbidities. These findings suggest that, compared to individuals with OA, those with RA have an increased short-term risk of MI following TKR. While risk of MI remains below 1%, this does underline the importance of the management of cardiovascular risk factors for those with RA. RA was also associated with an increased long-term risk of revision following THR, which strengthens the argument for investing in therapies which may prevent the need for joint replacement.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Hip ; Knee ; Arthroplasty ; Osteoarthritis ; Surgery
Publicat a:	Clinical Epidemiology, Vol. 10 (june 2018) , p. 697-704, ISSN 1179-1349

DOI: 10.2147/CLEP.S160347
PMID: 29942159

8 p, 535.7 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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