NEW YORK (Reuters Health) – Before newer, more effective drugs became available for treating rheumatoid arthritis, more than half of patients with the condition required orthopedic surgery, including a joint replacement in many cases, Swedish researchers report.

Rheumatoid arthritis is chronic autoimmune disease, meaning that the body attacks itself. Pain, swelling, stiffness, inflammation, and, sometimes, destruction of the joints are common features of the disease. In recent years, a number of “biologic” drugs, such as Enbrel, Remicade, and Humira, have come out that have proven to be particularly effective.

“This study could serve as a reference for comparison with cohorts of patients with rheumatoid arthritis recruited today, in which new, more efficacious treatments are used,” Dr. M. C. Kapetanovic and colleagues write in the Annals of the Rheumatic Diseases.

Kapetanovic’s group at Lund University initiated their study in 1985, roughly two decades before biologic drugs were introduced. Data from 183 patients with recent-onset rheumatoid arthritis were included in the analysis.

“The approach to (drug) treatment was conservative compared with current treatment strategies in early rheumatoid arthritis,” they note.

By the end of 2005, 106 patients (58 percent) underwent at least one surgery. In total, 386 orthopedic operations were performed, primarily removal of the joint surfaces of the shoulder, elbow, wrist and finger joints.

Forty-four patients (24 percent) underwent joint replacement involving the hip, knee, shoulder, elbow, or wrist. Eleven patients underwent three or more of these large joint replacements.

Laboratory tests of inflammation as well as certain joint parameters seen on x-rays predicted the need for joint surgery. By contrast, age, gender, symptom duration, and autoimmune test findings were not linked to surgery.

Kapetanovic and associates conclude: “The identification of factors associated with large joint (replacement) can lead to better tailored (drug) treatment to maintain function and prevent the disability of individual patients.”

SOURCE: Annals of the Rheumatic Diseases, October 2008.

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