Elena Nikiphorou1,2,3, Lewis Carpenter3, Sam Norton4, Stephen Morris2, Alex MacGregor5, Josh Dixey6, Peter Williams7, Patrick Kiely8, David Andrew Walsh9, Adam Young10,11. 1. ERAS, Department of Rheumatology, St Albans City Hospital, St Albans, UK. 2. Academic Rheumatology Department, King's College London, London, UK. 3. Whittington Hospital NHS Trust, London, UK. 4. Health Psychology Section, Institute of Psychiatry, King's College London, London, UK. 5. Institute of Musculoskeletal Science, University College London, London, UK. 6. Department of Rheumatology, New Cross Hospital, Wolverhampton, UK. 7. Department of Rheumatology, Medway Maritime Hospital, Gillingham, UK. 8. Department of Rheumatology, St Georges Healthcare Trust, London, UK. 9. Arthritis UK Pain Centre, University of Nottingham, Nottingham, UK. 10. ERAS, Department of Rheumatology, St Albans City Hospital, St Albans, UK. adam.young@nhs.net. 11. Whittington Hospital NHS Trust, London, UK. adam.young@nhs.net.
Abstract
PURPOSE OF REVIEW: The structural damage caused by rheumatoid arthritis (RA) can often be mitigated by orthopaedic surgery in late disease. This study evaluates the value of predictive factors for orthopaedic intervention. METHODS: A systematic review of literature was undertaken to identify papers describing predictive factors for orthopaedic surgery in RA. Manuscripts were selected if they met inclusion criteria of cohort study design, diagnosis of RA, follow-up duration/disease duration ≥3 years, any orthopaedic surgical interventions recorded, and then summarised for predictive factors. A separate predictive analysis was performed on two consecutive UK Early RA cohorts, linked to national datasets. RECENT FINDINGS: The literature search identified 15 reports examining predictive factors for orthopaedic intervention, 4 inception, 5 prospective and 6 retrospective. Despite considerable variation, acute phase, x-ray scores, women and genotyping were the most commonly reported prognostic markers. The current predictive analysis included 1602 procedures performed in 711 patients (25-year cumulative incidence 26%). Earlier recruitment year, erosions and lower haemoglobin predicted both intermediate and major surgery (P<0.05). Studies report variations in type of and predictive power of clinical and laboratory parameters for different surgical interventions suggesting specific contributions from different pathological and/or patient-level factors. Our current analysis suggests that attention to non-inflammatory factors in addition to suppression of inflammation is needed to minimise the burden of orthopaedic surgery.
PURPOSE OF REVIEW: The structural damage caused by rheumatoid arthritis (RA) can often be mitigated by orthopaedic surgery in late disease. This study evaluates the value of predictive factors for orthopaedic intervention. METHODS: A systematic review of literature was undertaken to identify papers describing predictive factors for orthopaedic surgery in RA. Manuscripts were selected if they met inclusion criteria of cohort study design, diagnosis of RA, follow-up duration/disease duration ≥3 years, any orthopaedic surgical interventions recorded, and then summarised for predictive factors. A separate predictive analysis was performed on two consecutive UK Early RA cohorts, linked to national datasets. RECENT FINDINGS: The literature search identified 15 reports examining predictive factors for orthopaedic intervention, 4 inception, 5 prospective and 6 retrospective. Despite considerable variation, acute phase, x-ray scores, women and genotyping were the most commonly reported prognostic markers. The current predictive analysis included 1602 procedures performed in 711 patients (25-year cumulative incidence 26%). Earlier recruitment year, erosions and lower haemoglobin predicted both intermediate and major surgery (P<0.05). Studies report variations in type of and predictive power of clinical and laboratory parameters for different surgical interventions suggesting specific contributions from different pathological and/or patient-level factors. Our current analysis suggests that attention to non-inflammatory factors in addition to suppression of inflammation is needed to minimise the burden of orthopaedic surgery.
Authors: D Jawaheer; J Olsen; M Lahiff; S Forsberg; J Lähteenmäki; I G da Silveira; F A Rocha; I M Magalhães Laurindo; L M Henrique da Mota; A A Drosos; E Murphy; C Sheehy; E Quirke; M Cutolo; S Rexhepi; J Dadoniene; S M M Verstappen; T Sokka Journal: Clin Exp Rheumatol Date: 2010-08-30 Impact factor: 4.473
Authors: Elena Nikiphorou; Lewis Carpenter; Stephen Morris; Alex J Macgregor; Josh Dixey; Patrick Kiely; David W James; David A Walsh; Sam Norton; Adam Young Journal: Arthritis Rheumatol Date: 2014-05 Impact factor: 10.995
Authors: A K Brown; P G Conaghan; Z Karim; M A Quinn; K Ikeda; C G Peterfy; E Hensor; R J Wakefield; P J O'Connor; P Emery Journal: Arthritis Rheum Date: 2008-10