Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Irazú Contreras-Yáñez, G. Guaracha-Basáñez, E. Díaz-Borjón, M. Iglesias, V. Pascual-Ramos

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

Login to get access

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

Early referral for appropriate management and flare control may prevent OHSI in Hispanic recent-onset RA patients.
Literature
1.
Mody GM, Cardiel MH. Challenges in the management of rheumatoid arthritis in developing countries. Best Pract Res Clin Rheumatol. 2008;22:621–41.CrossRef
2.
Pascual Ramos V, Contreras-Yáñez I, Villa AR, Cabiedes J†, Rull-Gabayet M. Medication persistence over two years of follow-up in a cohort of early rheumatoid arthritis patients: Associated factors and relationship with disease activity and disability. Arthritis Res Ther. 2009;11:R26.CrossRef
3.
Contreras-Yáñez I, Pascual-Ramos V. Predictors of health care drop-out in an inception cohort of patients with early onset rheumatoid arthritis. BMC Musculoskelet Disord. 2017;18:321.CrossRef
4.
Smolen JS, Breevedl FC, Burmester GR, Bykerk V, Dougados M, Emery P, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016;75:3–15.CrossRef
5.
Curkendall S, Patel V, Gleeson M, Campbell RS, Zagari M, Dubois R. Compliance with biologics therapies for rheumatoid arthritis: do patients out-of-pocket payments matter? Arthritis Rheum. 2008;59:1519–26.CrossRef
6.
Pascual-Ramos V, Conteras-Yáñez I. Motivations for inadequate persistence with disease modifying anti-rheumatic drugs in early rheumatoid arthritis: the patient’s perspective. BMC Musculoskelet Disord. 2013;14:336.CrossRef
7.
Anderson RJ. Controversy in the surgical treatment of the rheumatoid hand. Hand Clinic. 2011;27:21–5.CrossRef
8.
Alderman AK, Ubel PA, Kim HM, Fox DA, Chung KC. Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeon. J Rheumatol. 2003;30:1464–72.PubMed
9.
James D, Young A, Kulinskaya E, Knight E, Thompson W, Ollier W, et al. On behalf of the early rheumatoid arthritis study group (ERAS), UK. Orthopaedic intervention in early rheumatoid arthritis. Occurrence and predictive factors in an inception cohort of 1064 patients followed for 5 years. Rheumatology. 2004;53:369–76.
10.
Verstappen SM, Hoes JN, Ter Borg EJ, Bijlsma JW, Blaauw AA, Van Albada-Kuipers GA, on behalf of the Utrecht rheumatoid arthritis cohort study group, et al. Joint surgery in the Utrecht rheumatoid arthritis cohort: the effect of treatment strategy. Ann Rheum Dis. 2006;65:1506–11.CrossRef
11.
Gwinnutt JM, Symmons DPM, MacGregor AJ, Chipping JR, Lapraik C, Marshall T, et al. Predictors of and outcomes following orthopaedic joint surgery in patients with early rheumatoid arthritis followed for 20 years. Rheumatology. 2017;56:1510–7.CrossRef
12.
Kapetanovic MC, Lindqvist E, Saxne T, Eberhardt K. Orthopaedic surgery in patients with rheumatoid arthritis over 20 years: prevalence and predictive factors of large joint replacement. Ann Rheum Dis. 2008;67:1412–6.CrossRef
13.
Moura CS, Abrahamowicz M, Beauchamp ME, Lacaille D, Wang Y, Boire G, et al. Early medication use in new-onset rheumatoid arthritis may delay joint replacement: results of a large population-based study. Arthritis Res Ther. 2015;17:197.CrossRef
14.
Nikiphorou E, Norton S, Young A, Carpenter L, Dixey J, Walsh DA, et al. On behalf of ERAS and ERAN: association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopedic surgery. Combined analysis of two prospective cohort supports EULAR treat to target DAS thresholds. Ann Rheum Dis. 2016;75:2080–6.CrossRef
15.
van Gestel AM, Prevoo ML, Van’t Hof MA, van Rijswijk MH, Van de putte LB, van Riel PL. Development and validation of the European league against rheumatism response criteria for rheumatoid arthritis. Arthritis Rheum. 1996;39:34–40.CrossRef
16.
17.
Pérez-Román DI, Ortiz-Haro AB, Ruiz-Medrano E, Contreras-Yáñez I, Pascual-Ramos V. Outcomes after rheumatoid arthritis patients complete their participation in a long-term observational study with tofacitinib combined with methotrexate: practical and ethical implications in vulnerable populations after tofacitinib discontinuation. Rheumatol Intl. 2018;38:599–606.CrossRef
18.
Eberhardt K, Fex E, Johnson U, Wollheim FA. Association of HLA-DRB and –DQ genes with 2 and 5 year outcome in rheumatoid arthritis. Ann Rheum Dis. 1996;55:34–9.CrossRef
19.
Palm TM, Kaarela K, Hakala MS, Kautiainen HJ, Kröger HP, Belt EA. Need and sequence of large joint replacements in rheumatoid arthritis. A 25-year follow-up. Clin Exp Rheumatol. 2002;20:392–4.PubMed
20.
De Piano LP, Golmia RP, Scheinberg MA. Decreased need of large joint replacement in patients with rheumatoid arthritis in a specialized Brazilian center. Clin Rheumatol. 2011;30:549–50.CrossRef
21.
da Silva E, Doran MF, Crowson CS, O'Fallon WM, Matteson EL. Declining use of orthopedic surgery in patients with rheumatoid arthritis? Results of a long-term, population-based assessment. Arthritis Rheum. 2003;49:216–20.CrossRef
22.
Weiss RJ, Ehlin A, Montgomery SM, Wick MC, Stark A, Wretenberg P. Decrease of RA-related orthopedic surgery of the upper limbs between 1998 and 2004: data from 54579 Swedish RA inpatients. Rheumatol. 2008;47:491–4.CrossRef
23.
Nikiphorou E, Carpenter L, Morris S, McGregor AJ, Dixey J, Kiely P, et al. Hand and foot surgery decline rates in rheumatoid arthritis have declined from 1986 to 2011, but large joint replacement rates remain unchanged: results from the UK inception cohort. Arthritis Rheumatol. 2014;66:1081–9.CrossRef
24.
Sokka T, Kautiainen H, Hannonen P. Stable occurrence of knee and hip total joint replacement in Central Finland between 1986 and 2003; an indication of improved long-term outcomes of rheumatoid arthritis. Ann Rheum Dis. 2007;66:341–4.CrossRef
25.
Aaltonen KJ, Virkki LM, Jamsen E, Sokka T, Konttinen YT, Peltomaa R, et al. Do biologic drugs affect the need for and outcome of joint replacements in patients with rheumatoid arthritis? A register-based study. Sem Arthritis Rheum. 2013;43:55–62.CrossRef
26.
Asai S, Takahashi N, Funahashi K, Yoshioka Y, Takemoto T, Terabe K, et al. Concomitant methotrexate protects against total knee arthroplasty in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitor. J Rheumatol. 2015;42:2255–60.CrossRef
27.
Markusse IM, Dirven L, Gerards AH, van Groenendael JH, Ronday HK, Kerstens PJ, et al. Disease flares in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study. Arthtitis Res Ther. 2015;17:232.CrossRef
28.
Bykerk VP, Shadick N, Frits M, Bingham CO 3rd, Jeffery I, Iannaccone C, Weinblatt M, et al. Flares in rheumatoid arthritis: frequency and management. A report from the BRASS registry. J Rheumatol. 2014;41:227–34.CrossRef
29.
Lee JK, Choi CH. Total knee arthroplasty in rheumatoid arthritis. Review article. Knee Surg Relat Res. 2012;24:1–6.CrossRef
30.
Wolfe F, Zwillich SH. The long-term outcomes of rheumatoid arthritis. 23 year prospective, longitudinal study of total joint replacement and its predictors in 1600 patients with rheumatoid arthritis. Arthritis Rheum. 1998;41:1072–82.CrossRef
31.
Loza E, Abásolo L, Clemente D, López-González R, Rodríguez L, Vadillo C, et al. Variability in the use of orthopedic surgery in patients with rheumatoid arthritis in Spain. J Rheumatol. 2007;34:1484–90.
32.
Emery P, Breedveld FC, Dougados M, Kalden JR, Schiff MH, Smolen JS. Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis. 2002;61:290–7.CrossRef
33.
Inanc M. Very early ‘rheumatoid’ arthritis cohorts: limited by selection. Editorial. Rheumatology. 2007;46:185–7.CrossRef
34.
Kuijper TM, Lamers-Karnebeeck FB, Jacobs JW, Hazes JM, Luime JJ. Flare rate in patients with rheumatoid arthritis in low disease activity or remission when tapering or stopping synthetics or biologic DMARD: a systematic review. J Rheumatol. 2015;42:2012–22.CrossRef
Metadata
Title
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
Authors
Irazú Contreras-Yáñez
G. Guaracha-Basáñez
E. Díaz-Borjón
M. Iglesias
V. Pascual-Ramos
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2299-9

Other articles of this Issue 1/2018

BMC Musculoskeletal Disorders 1/2018 Go to the issue

Research article

Parameters influencing hand grip strength measured with the manugraphy system

Research article

Development, validity and reliability of the Italian version of the Copenhagen neck functional disability scale

Research article

Up-regulated expression of E2F2 is necessary for p16INK4a-induced cartilage injury

Research article

Mismatch between femur and tibia coronal alignment in the knee joint: classification of five lower limb types according to femoral and tibial mechanical alignment

Case report

An unexpected cause of sacroiliitis in a patient with gout and chronic psoriasis with inflammatory arthritis: a case report

Research article

Coronal and sagittal balance in Lenke 5 AIS patients following posterior fusion: important role of the lowest instrument vertebrae selection