Evolving Characteristics of Rheumatoid Arthritis Patients Receiving Primary Hip or Knee Arthroplasty: A 21-Year...

Although advances in disease-modifying therapies have improved rheumatoid arthritis (RA) management, many patients still require total hip or knee arthroplasty. Long-term data on baseline characteristics and treatment patterns of RA patients undergoing arthroplasty in China are scarce. This study aimed to investigate time trends in baseline demographic, clinical, laboratory, and treatment parameters of RA patients undergoing THA and TKA between 2002 and 2022.

A retrospective study of consecutive THAs and TKAs for RA patients between 2002 and 2022 was conducted at a single center. The preoperative patient demographics, clinical and laboratory parameters were collected. All joints were divided into 2002-2011 and 2012-2022 groups, THA and TKA groups, juvenile-onset rheumatoid arthritis (JORA) (0-16 years), adult-onset rheumatoid arthritis (AORA) (16-60 years), and late-onset rheumatoid arthritis (LORA) (≥ 60 years) groups, respectively. The intergroup comparisons were performed.

A total of 1363 primary TKAs in 897 patients with RA and 561 hips in 511 patients with RA were included. The number of arthroplasties performed annually from 2002 to 2022 demonstrated a significantly increasing trend. The use of glucocorticoids (GCs) before surgery demonstrated a significant decreasing trend while conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs) + targeted synthetic DMARDs (tsDMARDs) demonstrated an increasing trend. Comparison by time period (2002-2011 vs. 2012-2022) showed that the percentage of preoperative use of csDMARDs and bDMARDs + tsDMARDs was significantly higher and GCs were significantly higher in the 2002-2011 group.

The number of THAs and TKAs performed annually from 2002 to 2022 demonstrated a significantly increasing trend in a tertiary care center for musculoskeletal diseases. In contrast, a significantly increasing trend for the percentage of preoperative use of csDMARDs and bDMARDs + tsDMARDs and a significantly decreasing trend for preoperative use of GCs and inflammatory markers was identified.