Related Experiment Video
Updated: Aug 5, 2026
Erosion Identification in Metacarpophalangeal Joints in Rheumatoid Arthritis using High-Resolution Peripheral Quantitative Computed Tomography
Published on: October 6, 2023
Understanding the Effect of Meeting Performance Measures on the Outcomes of Joint Replacement in Rheumatoid
Claire E H Barber1, Hui Xie2, Yufei Zheng3
1C.E.H. Barber, MD, PhD, Departments of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia.
Objective:
Canadian performance measures (PMs) evaluate the quality of rheumatoid arthritis (RA) care; however, limited evidence exists linking these process measures to long-term patient outcomes. This research evaluated the effect of meeting PMs in early RA on 10-year risk of total joint replacement (TJR) of any joint.
Methods:
This was a retrospective propensity score-matched population-based cohort study in people with RA diagnosed between 2000 and 2008 who were followed until 2019. The exposure of interest was meeting the PMs within 2 years of diagnosis. Cox proportional hazard models were developed to examine the 10-year risk of TJR in 4 matched cohorts where PMs were met vs not met. PMs included access to rheumatology care, retention in care, early disease-modifying antirheumatic drug (DMARD) use, and ongoing DMARD therapy.
Results:
Among 19,765 individuals with RA, 44.78% had access to a rheumatologist within 1 year of diagnosis and 24.91% were retained in care; only 24.30% were dispensed a DMARD within 30 days, and 32.66% received a DMARD annually for the first 2 years. Meeting the PMs was associated with a neutral effect on risk of TJR at 10 years in our propensity score-matched analysis for 3 of the PMs, whereas a slightly elevated risk (hazard ratio 1.19, 95% CI 1.03-1.37) was shown for those receiving a DMARD at least annually.
Conclusion:
There were deficits in RA care identified at a population level; however, no clear protective effect of adherence to PMs was found. Future measure development efforts should focus on PMs with a greater effect on patient outcomes.