Orthopedic visits and procedures preceding rheumatoid arthritis diagnosis: A nationwide case-control study

Rheumatoid arthritis (RA) may initially present with nonspecific musculoskeletal symptoms before formal diagnosis, often prompting orthopedic visits and subsequent orthopedic procedures. We aimed to examine whether such procedures are more frequent among individuals prior to RA diagnosis compared to RA-free matched controls.

We conducted a retrospective case-control study using Leumit Healthcare Services electronic database. Each subject diagnosed with RA between 2002 and 2023 was matched with 5 controls based on age, sex, and socioeconomic status (SES). Orthopedic visits and procedures during the 5-year periods before diagnosis were identified.

The study included 4405 RA patients and 22,025 age, sex and socioeconomic status matched controls. RA cases were more likely to have comorbidities, including higher rates of diabetes, chronic obstructive pulmonary disease, osteoporosis, and fibromyalgia (all P<0.01). Orthopedic visits were significantly more frequent among RA cases compared to controls (79.7% vs. 58.4%; OR: 2.80, 95% CI: 2.28-2.72), with 7.9% of cases consulting hand specialists compared to 3.3% of controls (OR: 2.3, 95% CI: 2.00-2.63). A temporal gradient was observed, with the strongest associations occurring in the year preceding RA diagnosis. Orthopedic surgical procedures were also more common, with notable differences in hand-related surgeries, including carpal tunnel release (1.23% vs. 0.48%; OR: 2.57, 95% CI: 1.81-3.60), trigger finger repair (0.48% vs. 0.10%; OR: 1.88, 95% CI: 1.08-3.16), and arthroplasty of the hand, fingers, or wrist (0.18% vs. 0.04%; OR: 4.01, 95% CI: 1.37-11.28). No significant differences were observed for most other surgical procedures, including shoulder, spine, or foot.

Prior to their formal diagnosis, RA patients seek more orthopedic and hand surgeon services in the years preceding diagnosis, compared to matched controls. These findings highlight the importance of orthopedic care in early referral for rheumatologic services to facilitate early and timely diagnosis.