Variability in the Use of Orthopedic Surgery in Patients with Rheumatoid Arthritis in Spain

ESTIBALIZ LOZA, LYDIA ABÁSOLO, DANIEL CLEMENTE, RUTH LÓPEZ-GONZÁLEZ, LUIS RODRÍGUEZ, CRISTINA VADILLO, BENJAMIN FERNÁNDEZ-GUTIÉRREZ, PILAR MACARRÓN, JUAN A. JOVER, and CÉSAR HERNÁNDEZ-GARCÍA

ABSTRACT.

Objective. To analyze sociodemographic and clinic-associated factors of patients with rheumatoid arthritis (RA) undergoing any orthopedic surgery (AOS) and total joint replacement (TJR) in Spain.

Methods. A retrospective medical record review was performed in a probabilistic sample of 1379 RA patients from 46 centers distributed in 16 of 19 regions in Spain. Sociodemographic and clinical features, use of drugs, and arthritis-related joint surgeries were recorded following a standardized protocol. Gross domestic product (GDP) data were obtained from the National Statistical Index.

Results. Of 1379 patients, a total of 358 (26%) underwent one or more joint surgeries, and 194 (14%) had a TJR. The median time to first orthopedic procedure was 12.5 years from presentation of RA and the estimated rate was 5.6 surgeries per 100 person-years. The rate of AOS was increased in women, patients with RA with extraarticular complications, with longterm RA (> 10 yrs), with functional grade III-IV, and with persistent inflammatory disease. The risk factors for undergoing a TJR were longterm RA, functional grade III-IV, and extraarticular complications. Patients from regions with higher GDP per capita were more likely to undergo a procedure.

Conclusion. Clinical variables reflecting disease activity and severity are predictors of orthopedic surgery, but geographic and socioeconomic variables were also independently associated with the rate of orthopedic surgery. (First Release June 1 2007; J Rheumatol 2007;34:1485-90)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
ORTHOPEDIC SURGERY
VARIABILITY

---

From the Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, Spain.

Supported in part by Novartis Pharmaceutics, Barcelona, Spain.

E. Loza, MD; L. Abásolo, MD; D. Clemente, MD; R. López-González, MD; L. Rodríguez, MD; C. Vadillo, MD; B. Fernández-Gutiérrez, MD, PhD; P. Macarrón, MD; J.A. Jover, MD, PhD; C. Hernández-García, MD, PhD, Servicio de Reumatología.

Address reprint requests to Dr. C. Hernández-García, Servicio de Reumatología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain. E-mail: chernandez.hcsc@salud.madrid.org

Accepted for publication March 6, 2007.

---