Objectives To study the impact of the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and associated rheumatoid arthritis (RA) management guidelines on the incidence of total hip (THR) and knee replacements (TKR) in Denmark. Methods Nationwide register-based cohort and interrupted time-series analysis. Patients with incident RA between 1996 and 2011 were identified in the Danish National Patient Register. Patients with RA were matched on age, sex and municipality with up to 10 general population comparators (GPCs). Standardised 5-year incidence rates of THR and TKR per 1000 person-years were calculated for patients with RA and GPCs in 6-month periods. Levels and trends in the pre-bDMARD (1996–2001) were compared with the bDMARD era (2003–2016) using segmented linear regression interrupted by a 1-year lag period (2002). Results We identified 30 404 patients with incident RA and 297 916 GPCs. In 1996, the incidence rate of THR and TKR was 8.72 and 5.87, respectively, among patients with RA, and 2.89 and 0.42 in GPCs. From 1996 to 2016, the incidence rate of THR decreased among patients with RA, but increased among GPCs. Among patients with RA, the incidence rate of TKR increased from 1996 to 2001, but started to decrease from 2003 and throughout the bDMARD era. The incidence of TKR increased among GPCs from 1996 to 2016. Conclusion We report that the incidence rate of THR and TKR was 3-fold and 14-fold higher, respectively among patients with RA compared with GPCs in 1996. In patients with RA, introduction of bDMARDs was associated with a decreasing incidence rate of TKR, whereas the incidence of THR had started to decrease before bDMARD introduction.

/pdf/incidence-of-hip-and-knee-replacement-in-patients-with-56mktcvi1y.pdf

Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time-series analysis using nationwide Danish healthcare registers

Objective: To examine the effectiveness of orthopaedic surgery in patients with inflammatory arthropathies with regard to longitudinal changes in pain, physical function and health-related quality of life and explore differences in effectiveness between replacement versus non-replacement surgery and surgery in the upper versus the lower limb. Methods: 255 patients (mean age 57.5 years (SD 13.1), 76.7% female) with inflammatory arthropathies underwent orthopaedic surgical treatment and responded to mail surveys at baseline and during follow-up (3, 6, 9 and 12 months). The booklet of questionnaires included the arthritis impact measurement scales 2 (AIMS2), health assessment questionnaire (HAQ), short form 36 (SF-36), EQ-5D and visual analogue scales (VAS) addressing patient global, fatigue, general pain and pain in the actual joint. Standardised response means (SRM) were calculated to estimate the magnitude of improvement. Results: Significant improvement was seen for most of the dimensions of health, the largest improvement for pain in the actual joint (SRM 1.17) at one year follow-up. SRM for AIMS-2 physical, SF-36 physical and HAQ were 0.1, 0.48 and 0.05, respectively. The overall numeric improvement (SRM) in utility was 0.10 (0.37) with EQ-5D and 0.03 (0.27) with SF-6D. Improvement overall was similar after surgery in the upper versus the lower limb, but was larger in patients undergoing replacement surgery than in patients undergoing other surgical procedures (SRM 1.54 vs 1.08 for pain in the actual joint). Conclusions: Surgical procedures have a major positive impact on pain in the actual joint, but improvement is less in other dimensions of health. Health benefits were larger after replacement surgery than after other surgical procedures.

https://ard.bmj.com/content/annrheumdis/68/10/1596.full.pdf

Orthopaedic surgery in 255 patients with inflammatory arthropathies: longitudinal effects on pain, physical function and health-related quality of life.

Objective. The "Comprehensive ICF Core Set for rheumatoid arthritis" represents the typical spectrum of problems in functioning of patients with rheumatoid arthritis according to the International Classification of Functioning, Disability and Health (ICF). The objective of this study was to validate this ICF Core Set from the perspective of physicians. Methods. Physicians experienced in rheumatoid arthritis treatment were asked about the problems they commonly treat in patients with rheumatoid arthritis in a 3-round survey using the Delphi technique. Responses were linked to the ICF. Results. Seventy-nine physicians in 41 countries named 512 patients' problems. Two hundred and 27 ICF categories were linked to these answers. Twenty-six ICF categories were not represented in the Comprehensive ICF Core Set for rheumatoid arthritis and 19 aspects were not covered by the ICF. Conclusion. The content validity of 3 ICF components was well supported. However, several body functions were identified that are not covered and need to be investigated further.

Validation of the comprehensive ICF Core Set for rheumatoid arthritis: the perspective of physicians.

To investigate the influence of disease severity within cardiovascular disease (CVD) and musculoskeletal (MSK) disorder spectrums on physical health change over 3 years. Consultation records of 4,672 patients aged 50 years and above from six general practices were linked to their baseline and 3-year Short-Form-12 (SF-12) physical component summary (PCS) scores. Associations between exclusive diagnostic categories and comorbid counts with physical health change over 3 years were examined. There were 1,371 (29.3%) CVD and 1,972 (42.2%) MSK consulters. Adjusted additional change in PCS scores relative to hypertension ranged from −0.43 (95% confidence interval −2.5, 1.7) for atrial fibrillation to −2.09 (−4.2, 0.0) for heart failure. In the MSK spectrum, changes relative to soft tissue disorder ranged from −0.63 (−3.0, 1.8) for soft tissue pain to −1.09 (−4.1, 2.0) for inflammatory polyarthropathy. A trend in association between increasing disease severity and deterioration in physical health was only observed within the CVD spectrum, and this trend was retained in those with CVD and higher levels of comorbidity. CVD severity with higher levels of comorbidity was associated with greater relative deterioration in long-term physical health. Such findings were not found for the MSK cohorts, suggesting the differing health impact of different chronic diseases.

Influence of chronic diseases on long-term change in physical health: a consultation-survey linkage cohort study in general practice.

Patients with rheumatoid arthritis (RA) frequently present with pain under their feet. Forefoot bursae can give rise to such symptoms, but are rarely investigated. The aim of this thesis was to use musculoskeletal ultrasound (MSUS) performed by a podiatrist to evaluate the prevalence and natural history of bursae in the forefoot in RA patients. Once reliability of technique was established, a longitudinal study design was used in which a sample of RA patients (N=149) and a comparator group (N=50) of healthy individuals were assessed at baseline. A Diasus MSUS system was used to image the forefeet of all participants to determine prevalence of bursae. 120 patients (98 female, 22 male) with RA (24 seronegative, 93 seropositive, 3 unknown) completed the study at twelve months: mean age 60.7 (SD 12.1) years and disease duration 12.99 (10.4) years. Results confirmed a high prevalence of forefoot bursae (92.6% of patients; mean per individual =3.54, range 0-9) and that these were often missed by clinical examination. Findings that there could be an association between patient reported foot impact scales of impairment/footwear (LFISIF) and activity participation restriction/limitation (LFISAP) and presence of bursae (LFISIF ?=0.377, p=0.033; LFISAP ?=0.762, p=0.013) independent of
disease activity were unique. On examination of prospective data after one year, 25.8% of participants had increases in bursae and 23.3% decreases. There was a significant
correlation between changes in bursae with changes in LFISIF (PCC=0.216, p=0.018) and LFISAP (PCC=0.193, p=0.036) and a significant negative correlation with changes in duration of RA (PCC=-0.269, p=0.003). The findings imply that MSUS detectable bursae in the forefeet are highly prevalent, clinically under-reported and change over time. The findings suggest that bursae within the foot in RA deserve increased clinical attention and that further work is required to confirm associations with patient reported foot impact outcome measures.

The investigation of bursae in the forefoot of patients with rheumatoid arthritis using musculosketal ultra sound imaging performed by a podiatrist

Objective: To examine the overall magnitude of change in self‐reported physical function over a 10‐year period in patients with rheumatoid arthritis (RA), and to compare changes in physical function between the lower and upper limbs.Methods: Self‐reported data on physical function were collected from the patients in the Oslo RA register (ORAR) through mail surveys between 1994 and 2004. The change in overall physical function was measured by the Short Form 36 (SF‐36), the Modified Health Assessment Questionnaire (MHAQ), and the Arthritis Impact Measurement Scales (AIMS2). The MHAQ and AIMS2 were used to address activities related to lower and upper limb function. The magnitude of changes was expressed as crude and adjusted changes and standardized response means (SRMs). The analyses were adjusted for age, sex, duration of disease, and number of surgical procedures in the lower and upper limbs.Results: A total of 414 patients [323 (78%) females, mean age 54.9 years and median disease duration 11.6 years] w...

/pdf/patients-with-rheumatoid-arthritis-report-greater-physical-3vrfevjhax.pdf

Patients with rheumatoid arthritis report greater physical functional deterioration in lower limbs compared to upper limbs over 10 years.

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Patients with rheumatoid arthritis report greater physical functional deterioration in lower limbs compared to upper limbs over 10 years.