Increased Risk of Common Orthopedic Surgeries for Patients with Rheumatic Diseases in Taiwan

Area of Science:

• Rheumatology
• Orthopedic Surgery
• Epidemiology

Background:

• Rheumatic diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriasis, and systemic lupus erythematosus (SLE) are associated with chronic arthritis and potential joint/spine destruction.
• Previous research indicates an elevated risk of major orthopedic surgeries in patients with these conditions.
• Taiwan's National Health Insurance Research Database (NHIRD) provides a valuable resource for studying these epidemiological trends.

Purpose of the Study:

• To review and summarize the risk of total knee replacement (TKR), total hip replacement (THR), and spinal surgery (cervical and lumbar) in patients diagnosed with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and SLE.
• To analyze surgical risks based on data from Taiwan's NHIRD.

Main Methods:

• A comprehensive review of previously published studies and unpublished findings utilizing data from Taiwan's NHIRD.
• Analysis focused on the incidence of TKR, THR, cervical spine surgery, and lumbar spine surgery among patients with specific rheumatic diseases.

Main Results:

• Increased risk of TKR observed in patients with rheumatoid arthritis, psoriasis, and male patients with ankylosing spondylitis.
• Elevated risk of THR noted in patients with rheumatoid arthritis, ankylosing spondylitis, and female patients with SLE.
• An increased risk of cervical spine surgery was found only in patients with ankylosing spondylitis, while both rheumatoid arthritis and ankylosing spondylitis patients showed increased risk for lumbar spine surgery.
• While risks appear to be declining with biologic use, direct evidence on biologic impact is pending.

Conclusions:

• Patients with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and SLE exhibit a significantly higher risk for common orthopedic surgeries.
• Clinical vigilance is essential to mitigate risks, particularly for TKR/THR in rheumatoid arthritis patients, THR in young ankylosing spondylitis patients, THR in young female SLE patients, and cervical spine surgery in young ankylosing spondylitis patients.