FRI0523 THE RECENT TREND OF ORTHOPAEDIC SURGERIES FOR RHEUMATOID ARTHRITIS. AN ANALYSIS OF 1569 CASES FROM 2004 TO 2019.
Authors: Y. Hotta, Y. Nasu, K. Nishida, M. Matsuhashi, M. Watanabe, R. Nakahara, T. Ozaki
Journal: Annals of the Rheumatic Diseases (2020)

Background: In Japan, Methotrexate (MTX) has been approved in 1999, the first biologic DMARD (bDAMRD) in 2003, and the Janus kinase (JAK) inhibitors have been used since 2013. Although it is expected that the recent advancement of drug therapy would contribute the decrease in the incidence of orthopaedic surgeries by preventing structural damages 1, 2) , we are still facing a considerable number of patients who require surgical interventions 3) . Objectives: To investigate the recent trends of patient’s background who underwent the orthopaedic surgery for rheumatoid arthritis, number of orthopaedic intervention, and the type of the surgery. Methods: We reviewed the records of 1569 patients with RA who underwent orthopedic surgeries between 2004 and 2019 in our institution. The mean age of patients was 62.8 (22-88) years-old with disease duration of 20.9 (0.5-64) years. Data of these patients such as age, disease duration, medication (Glucocorticoid; GC, MTX, b/tsDMARD), type of surgeries (total joint replacement; TJR, hand surgery, foot surgery, spine surgery, and others), and preoperative serum CRP level were collected. We analyzed the annual change of these demographic and clinical data. Then, we compared them between CRP negative (&lt;1.5g/l) and CRP positive group. Cochran-Armitage trend test,χ square test, or unpaired T-test was performed for statistical analysis. P &lt;0.05 was considered significant. Results: Among all cases, 426 cases (27.2%) were treated with b/tsDMARDs at the time of operation. MTX and GC were used in 937 cases (59.7%) and 1015 cases (64.7%), respectively. The mean age and disease duration of RA showed an increasing trend, although the CRP level was dramatically decreased during the study period. While the rate of MTX use has not changed significantly (p=0.102), the number of cases treated by b/ts DMARD increased significantly to 46.7% (p&lt;0.001). In contrast, the rate of GC use dicreased significantly (p&lt;0.001). Although the annual number of surgeries have not changed, the proportion of cases who performed TJR decreased dramatically (59.6% in 2011, 29.5% in 2019), and the surgeries for hand and foot increased significantly (p&lt;0.001) (Fig 1). The annual mean preoperative CRP level also decreased from 18.8±1.95 to 4.89±0.81 (Fig 2). Compared to CRP positive group (n=1,113), the patients in CRP negative group (n=446) showed significantly younger age(p&lt;0.001), shorter disease duration (p=0.031), lower late of GC use, and a higher rate of b/tsDAMRD use. The proportion of patients who underwent TJR was significantly higher in CRP positive group (p&lt;0.001). Conclusion: Along with the increasing use of b/tsDMARD, the preoperative disease control of RA, as well as the type of demanded surgeries have dramatically changed. References: [1] Yamanaka H, Tanaka E, Nakajima A, et al. A large observational cohort study of rheumatoid arthritis, IORRA: Providing context for today’s treatment options. Mod Rheumatol 2020;30:1-6. [2] Matsumoto T, Nishino J, Izawa N, et al. Trends in Treatment, Outcomes, and Incidence of Orthopedic Surgery in Patients with Rheumatoid Arthritis: An Observational Cohort Study Using the Japanese National Database of Rheumatic Diseases. J Rheumatol 2017;44:1575-82. [3] Momohara S, Tanaka S, Nakamura H, et al. Recent trends in orthopedic surgery performed in Japan for rheumatoid arthritis. Mod Rheumatol 2011;21:337-42. Disclosure of Interests: Yoshifumi Hotta: None declared, Yoshihisa Nasu: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Minami Matsuhashi: None declared, Masahito Watanabe: None declared, Ryuichi Nakahara: None declared, Toshifumi Ozaki: None declared