Incident osteoarthritis and osteoarthritis-related joint replacement surgery in patients with ankylosing spondylitis: A secondary cohort analysis of a nationwide, population-based health claims database

Objective.Disease-modifying antirheumatic drugs (DMARD) have the greatest effect when initiated early. We evaluated the influence of early exposure to DMARD on time to joint replacement surgery among patients with incident rheumatoid arthritis (RA).Method.Using a common protocol, we undertook 2 independent population-based cohort studies of patients with incident RA aged 66 years or older in Ontario (ON) and Quebec (QC) covering the period 2000–2013. We used Cox proportional hazards regression with time-dependent variables measuring duration of drug use in the first year, separately for methotrexate (MTX) and other DMARD, adjusting for baseline demographics, clinical factors, and other potentially confounding drug exposures. Our outcome measure was any joint replacement derived from standardized procedure codes. Adjusted HR and 95% CI were estimated.Results.Among 20,918 ON and 6754 QC patients with RA followed for a median of 4.5 years, 2201 and 494 patients underwent joint replacement surgery for crude event rates of 2.0 and 1.4 per 100 person-years, respectively. Greater cumulative exposure to MTX (HR 0.97, 95% CI 0.95–0.98) and other DMARD (HR 0.98, 95% CI 0.97–0.99) in the first year after diagnosis was associated with longer times to joint replacement in ON, corresponding to a 2–3% decrease in the hazard of surgery with each additional month of early use. Similar results were observed in QC.Conclusion.Greater duration of exposure to DMARD soon after RA diagnosis was associated with delays to joint replacement surgery in both provinces. Early intensive treatment of RA may ultimately reduce demand for joint replacement surgery.

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Joint Replacement Surgery Booklet

Internal Medicine News ◽

10.1016/s1097-8690(07)71505-6 ◽

2008 ◽

Vol 41 (1) ◽

pp. 17

Keyword(s):

Joint Replacement ◽

Joint Replacement Surgery ◽

Replacement Surgery

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Would Allowing Privately Funded Health Care Reduce the Public Waiting Time? Theory and Empirical Evidence from Canadian Joint Replacement Surgery Data

SSRN Electronic Journal ◽

10.2139/ssrn.2154134 ◽

2012 ◽

Author(s):

Hong Chen ◽

Qu Qian ◽

Anming Zhang

Keyword(s):

Health Care ◽

Empirical Evidence ◽

Waiting Time ◽

Joint Replacement ◽

The Public ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Time Theory

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COVID-19 (SARS-CoV-2) lymphocyte responses are associated with inflammatory biomarkers in total joint replacement surgery candidates pre-operatively

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02563-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Marco S. Caicedo ◽

Vianey Flores ◽

Alicia Padilla ◽

Samelko Lauryn ◽

Joshua J. Jacobs ◽

...

Keyword(s):

Joint Replacement ◽

Total Joint Replacement ◽

Cross Reactivity ◽

Inflammatory Biomarkers ◽

Nucleocapsid Proteins ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Operative Planning ◽

Lymphocyte Responses ◽

Reactive Lymphocytes

Abstract Background Recent studies indicate that, in addition to antibody production, lymphocyte responses to SARS-CoV-2 may play an important role in protective immunity to COVID-19 and a percentage of the general population may exhibit lymphocyte memory due to unknown/asymptomatic exposure to SARS-CoV-2 or cross-reactivity to other more common coronaviruses pre-vaccination. Total joint replacement (TJR) candidates returning to elective surgeries (median age 68 years) may exhibit similar lymphocyte and/or antibody protection to COVID-19 prior to vaccination Methods In this retrospective study, we analyzed antibody titters, lymphocyte memory, and inflammatory biomarkers specific for the Spike and Nucleocapsid proteins of the SARS-CoV-2 virus in a cohort of n=73 returning TJR candidates (knees and/or hips) pre-operatively. Results Peripheral blood serum of TJR candidate patients exhibited a positivity rate of 18.4% and 4% for IgG antibodies specific for SARS-CoV-2 nucleocapsid and spike proteins, respectively. 13.5% of TJR candidates exhibited positive lymphocyte reactivity (SI > 2) to the SARS-CoV-2 nucleocapsid protein and 38% to the spike protein. SARS-CoV-2 reactive lymphocytes exhibited a higher production of inflammatory biomarkers (i.e., IL-1β, IL-6, TNFα, and IL-1RA) compared to non-reactive lymphocytes. Conclusions A percentage of TJR candidates returning for elective surgeries exhibit pre-vaccination positive SARS-CoV-2 antibodies and T cell memory responses with associated pro-inflammatory biomarkers. This is an important parameter for understanding immunity, risk profiles, and may aid pre-operative planning. Trial registration Retrospectively registered.

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