Biological DMARD guidelines associated with a reduced need for knee and hip replacements in RA

June 15, 2017

The results of a Danish study presented today at the Annual European Congress of Rheumatology (EULAR) 2017 press conference showed that the incidence of total knee replacements (TKR) carried out on patients with rheumatoid arthritis (RA) started to decrease after the introduction of biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) to national treatment guidelines.

Prior to 2002, when the new guidance was introduced, the incidence of TKR had been increasing among RA patients. In a general population of individuals matched in terms of their age, sex and where they lived, the incidence of TKR has continued to increase throughout the entire study period (1996-2016). In contrast, the incidence of TKR carried out on patients with RA started to decrease after the introduction of bDMARDs to national treatment guidelines.

The incidence of total hip replacements (THR) has also maintained a steady increase in this matched population whereas among RA patients, apart from a rather surprising increase in 2003, the incidence of THR has followed an ongoing both after and before the guidance was introduced.

Previous data have been conflicting regarding a possible impact of more aggressive treatment, including treatment with bDMARDs, on the need for knee and hip replacements in patients with RA.

"Our findings show a clear downward trend in these two operations in RA patients in Denmark since the addition of bDMARDs to treatment protocols", said lead author Dr. Lene Dreyer, from the Centre for Rheumatology and Spine Diseases, Gentofte, Copenhagen, Denmark. "Also, the overall pattern of our findings is in line with those recently reported from England and Wales."

"In addition, a more widespread use of conventional DMARDs and the treat to target strategy may have contributed to this positive development," Dr. Dreyer concluded.

With a TKR baseline incidence rate of 5.87 per 1,000 person years in RA patients, based on biannual data, before 2002 the incidence of TKR had been increasing at a rate of plus 0.19 per year. After 2003, the downward trend has been equivalent to a minus 0.20 reduction in incidence per year.

With a THR baseline incidence rate of 8.72 per 1,000 person years in RA patients, based on biannual data, the downward trend was equivalent to a minus 0.38 reduction in incidence per year both before 2002 and after 2003. In 2003, there was a temporary increase of plus 2.23 in THR incidence per year.

National guidelines recommending bDMARD treatment for RA were introduced in Denmark in 2002. In this analysis, trends in the pre-bDMARD guideline era (1996-2002) were compared with those in the bDMARD period (2003-2016). 5-year age and sex-standardised incidence rates of THR and TKR were calculated for 30,868 RA patients diagnosed bi-annually between 1996-2011, and compared with 301,527 matched (RA-free) controls.

Explore further: Drop in admission for aspiration pneumonia from 2002 to 2012

Related Stories

Drop in admission for aspiration pneumonia from 2002 to 2012

June 8, 2017
(HealthDay)—From 2002 to 2012 there was a decrease in the incidence of admission for aspiration pneumonia, according to research published in the June 1 issue of the Annals of the American Thoracic Society.

Rates of bowel disease in Denmark continue to rise

February 23, 2017
New research indicates that the incidence of inflammatory bowel disease—including ulcerative colitis (UC) and Crohn's disease (CD)—in Denmark is on the rise and is among the highest in the world.

Incidence of hospitalization for hypoglycemia decreasing

December 3, 2016
(HealthDay)—For patients with type 1 diabetes, the incidence of hospitalization for hypoglycemia (HH) decreased over time in Denmark, with an 8.4 percent annual decrease, according to a study published online Nov. 29 in ...

Increased incidence of bleeding near the brain linked to increased use of anti-clotting drugs

February 28, 2017
An increased incidence in Denmark of subdural hematoma (a bleed located within the skull, but outside the brain) from 2000 to 2015 appears to be associated with the increased use of antithrombotic drugs, such as low-dose ...

New Zealand's colorectal cancer rates are on the rise in young adults

April 5, 2017
A recent analysis found a decrease in the overall incidence of colorectal cancer in New Zealand, but an increased incidence of rectal cancer in those under 50 years of age.

State, regional differences in melanoma rates 2003 vs 2013

December 28, 2016
A new research letter published online by JAMA Dermatology compares melanoma death and incidence by states and in four geographic regions.

Recommended for you

Drug suppresses spread of breast cancer caused by stem-like cells

December 12, 2017
Rare stem-like tumor cells play a critical role in the spread of breast cancer, but a vulnerability in the pathway that powers them offers a strategy to target these cells using existing drugs before metastatic disease occurs, ...

MRI scans predict patients' ability to fight the spread of cancer

December 12, 2017
A simple, non-invasive procedure that can indicate how long patients with cancer that has spread to the brain might survive and whether they are likely to respond to immunotherapy has been developed by researchers in Liverpool.

A new weapon against bone metastasis? Team develops antibody to fight cancer

December 11, 2017
In the ongoing battle between cancer and modern medicine, some therapeutic agents, while effective, can bring undesirable or even dangerous side effects. "Chemo saves lives and improves survival, but it could work much better ...

Insights on how SHARPIN promotes cancer progression

December 11, 2017
Researchers at Sanford Burnham Prebys Medical Discovery (SBP) and the Technion in Israel have found a new role for the SHARPIN protein. In addition to being one of three proteins in the linear ubiquitin chain assembly complex ...

Glioblastoma survival mechanism reveals new therapeutic target

December 11, 2017
A Northwestern Medicine study, published in the journal Cancer Cell, has provided new insights into a mechanism of tumor survival in glioblastoma and demonstrated that inhibiting the process could enhance the effects of radiation ...

Liver cancer: Lipid synthesis promotes tumor formation

December 11, 2017
Lipids comprise an optimal energy source and an important cell component. Researchers from the Biozentrum of the University of Basel and from the University of Geneva have now discovered that the protein mTOR stimulates the ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.