Delayed anti-TNF therapy increases the risk of total knee replacement in patients with severe rheumatoid arthritis

BMC Musculoskeletal Disorders

Research Article

Tien-Tsai Cheng¹  Chi-Hua Ko¹  Ying-Chou Chen¹  Wen-Chan Chiu¹  Chung-Yuan Hsu¹  Ben Yu-Jih Su¹  Han-Ming Lai¹  Shan-Fu Yu¹  Jia-Feng Chen¹ 

[1] Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan;

关键词: DAS28;    Rheumatoid arthritis;    RA;    Anti-TNF therapy;    Total knee replacement;    TKR;    Delayed intervention;   

DOI  :  10.1186/s12891-017-1685-z

 received in 2016-09-30, accepted in 2017-07-17,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThis study evaluated the effect of early anti-tumor necrosis factor (TNF) therapy in patients with severe rheumatoid arthritis (RA) on the subsequent risk of total knee replacement (TKR) surgery.MethodsThis retrospective observational study included a hospital-based cohort of 200 patients diagnosed with severe RA who received treatment with anti-TNF therapy between 2003 and 2014. Clinical parameters including age, sex, body mass index, and the time from the diagnosis of RA to the initiation of anti-TNF therapy were analyzed.ResultsOf the 200 enrolled patients, 84 underwent an early intervention (≤3 years from the diagnosis of RA to the initiation of anti-TNF therapy), and 116 underwent a late intervention(>3 years from the diagnosis of RA to the initiation of anti-TNF therapy). Five (6.0%) patients in the early intervention group underwent TKR compared to 31 (26.7%) in the late intervention group (p = 0.023). After adjusting for confounding factors, the late intervention group still had a significantly higher risk of TKR (p = 0.004; odds ratio, 5.572; 95% confidence interval, 1.933–16.062). Those receiving treatment including methotrexate had a lower risk of TKR (p = 0.004; odds ratio, 0.287; 95% confidence interval, 0.122–0.672).ConclusionsDelayed initiation of anti-TNF therapy in the treatment of severe RA was associated with an increased risk of TKR surgery. Adding methotrexate treatment decreased the risk of future TKR.

【 授权许可】

CC BY   
© The Author(s). 2017