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Joint surgery rates in lupus: a long-term cohort study
Johannes Nossent1,2, Helen Isobel Keen3,4, David Brian Preen5
1Medical School, The University of Western Australia, Perth, Western Australia, Australia johannes.nossent@uwa.edu.au.
Lupus Science & Medicine
|January 10, 2024
Summary
Patients with Systemic Lupus Erythematosus (SLE) have a high burden of joint surgery, with rates of arthroplasty and arthrodesis remaining unchanged over time. Increased efforts are needed to prevent joint damage in SLE patients.
Area of Science:
- Rheumatology
- Orthopedic Surgery
- Systemic Lupus Erythematosus (SLE) Research
Background:
- Scarce data exists on the necessity and types of joint surgery required for Systemic Lupus Erythematosus (SLE).
- Understanding long-term joint procedure trends in SLE is crucial for patient management and resource allocation.
Purpose of the Study:
- To investigate the long-term rates and underlying causes of arthroplasty, arthrodesis, and synovectomy in patients with SLE.
- To compare joint surgery rates between SLE patients (including rhupus subtype) and propensity-matched controls.
Main Methods:
- Utilized state-wide Hospital Morbidity Data Collection (1985-2015) for SLE patients (n=1855) and controls (n=12,840).
- Classified SLE patients with rheumatoid arthritis codes as rhupus.
- Employed regression analysis to compare odds ratios (ORs) and incidence rates (IRs) for joint procedures (JPs) across study decades.
Main Results:
- Patients with SLE underwent significantly more JPs (11.6%) than controls (1.3%), with a 19.9-fold higher IR.
- Rhupus patients exhibited the highest odds for all three joint procedures (arthroplasty, arthrodesis, synovectomy).
- While avascular necrosis rates decreased, overall JP IR in rhupus remained stable, and arthroplasty/arthrodesis rates did not decline in other SLE patients over time.
Conclusions:
- The burden of joint surgery in SLE is substantial and persistent.
- Despite improvements in managing avascular necrosis, rates of major joint replacement and fusion have not decreased.
- There is an urgent need for enhanced strategies to mitigate joint damage in individuals with SLE.
