Risk of 30-day Readmission after Knee or Hip Replacement in Rheumatoid Arthritis and Osteoarthritis by non-Medicare and Medicare Payer Status

2021 ◽  
pp. jrheum.201370
Author(s):  
Ali Yazdanyar ◽  
Anthony Donato ◽  
Mary Chester Wasko ◽  
Michael M. Ward
Keyword(s):  
Rheumatoid Arthritis ◽  
Postoperative Complications ◽  
Knee Replacement ◽  
Hip Replacement ◽  
Index Hospitalization ◽  
Cardiac Events ◽  
Adjusted Risk ◽  
Significant Difference ◽  
Primary Payer ◽  
Nationwide Readmission Database

Objective To determine the indication and risk of 30-day rehospitalization after hip or knee replacement among rheumatoid arthritis (RA) and osteoarthritis (OA) by Medicare and non-Medicare status. Methods Using the Nationwide Readmission Database (2010-2014), we defined an Index hospitalization as an elective hospitalization with a principal procedure of total hip or knee replacement among adults aged ≥18 years. Primary payer was categorized as Medicare or non- Medicare. Survey logistic regression provided the odds of 30-day rehospitalization in RA relative to OA. We calculated the rates for principal diagnoses leading to rehospitalization. Results Overall, 3.53% of 2,190,745 index hospitalization had a 30-day rehospitalization. Patients with RA had a higher adjusted risk of rehospitalization after TKR (Odds Ratio [OR], 1.11; 95% Confidence Interval [CI], 1.02 to 1.21) and THR (OR, 1.39; 95% CI, 1.19 to 1.62). Persons with RA and OA did not differ with respect to rates of infections, cardiac events, or postoperative complications leading to the rehospitalization. After TKR, RA patients with Medicare had a lower VTE risk (OR, 0.58;95% CI, 0.58 to 0.88) while post-THR those with RA had a greater VTE risk (OR, 2.41;95% CI, 1.04 to 5.57). Conclusion RA patients had a higher 30-day rehospitalization than OA after TKR and THR regardless of payer type. While infections, postoperative complications, cardiac did not differ, there was a significant difference in venous thromboembolism as the rehospitalization's principal diagnosis.

scholarly journals Clinical outcome following primary total hip or knee replacement in nonagenarians

2016 ◽  
Vol 98 (04) ◽  
pp. 258-264 ◽  
Author(s):  
D Skinner ◽  
BJ Tadros ◽  
E Bray ◽  
M Elsherbiny ◽  
G Stafford
Keyword(s):  
Postoperative Complications ◽  
Knee Replacement ◽  
Age Groups ◽  
Mortality Rates ◽  
Patient Reported Outcome Measures ◽  
Control Group ◽  
Joint Replacements ◽  
Total Hip ◽  
Significant Difference ◽  
Patient Reported

Introduction The Elective Orthopaedic Centre in Epsom has an established patient reported outcome measures programme, into which all patients are enrolled. Postoperative complications, Oxford hip/knee scores (OHS/OKS) and EQ-5D™ (EuroQol, Rotterdam, Netherlands) scores are collected up to the second postoperative year. Our population is ageing and the number of joint replacements being performed on the very elderly is rising. The aim of this study was to investigate the outcome of joint replacements in a nonagenarian population. Methods Our dataset was reviewed retrospectively for a cohort of nonagenarians undergoing either a primary total hip replacement (THR) or total knee replacement (TKR) between April 2008 and October 2011. Postoperative complications, mortality rates and functional outcomes were compared with those of a time matched 70–79-year-old cohort. Results Nonagenarians requiring a THR presented with a lower preoperative OHS (p=0.020) but made a greater improvement in the first postoperative year than the younger cohort (p=0.040). The preoperative OKS was lower for nonagenarians than for the control group (p=0.022). At one and two years after TKR, however, there was no significant difference between the age groups. The nonagenarians had a greater risk of requiring a blood transfusion following both THR (p=0.027; 95% confidence interval [CI]: 1.11–5.75) and TKR (p=0.037; 95% CI: 1.08–16.65) while the latter cohort also required a longer stay than their younger counterparts (p=0.001). Mortality rates were higher in the nonagenarian group but these were in keeping with the life expectancy projections identified by the Office for National Statistics. Conclusions Over a two-year period, the functional outcome and satisfaction rates achieved by nonagenarians following a THR or TKR are comparable with 70–79-year-olds.

scholarly journals Karakteristike pacijenata sa implantiranom totalnom protezom zgloba kuka i kolena

2011 ◽  
Vol 58 (4) ◽  
pp. 55-59
Author(s):  
Kristina Zivkovic ◽  
Ljiljana Markovic-Denic ◽  
Vesna Bumbasirevic ◽  
Aleksandar Lesic ◽  
Emilija Dubljanin-Raspopovic ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Knee Replacement ◽  
Physical Condition ◽  
Hip Replacement ◽  
Regional Anaesthesia ◽  
Statistical Significance ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Study Results ◽  
Joint Disorder

Osteoarthrosis is the most frequent joint disorder in the world. An increased incidence of total hip replacement (THR) and total knee replacement (TKR) has been noticed recently. AIM: To investigate demographic characteristics, comorbidities, surgical factors and postoperative complications of patients who received THR or TKR. MATERIAL AND METHOD: Patients aged at least 30 years hospitalized at the Clinics for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, for THR or TKR between January 1, 2008 and January 1, 2010. were included in a retrospective cohort study. RESULTS: Out of 529 investigated patients, 421 (79.6%) were in the THR group, and 108 were in the TKR group. Patients in the TKR group were 68.7+7.8 year old in average and were significantly older than patients in the THR group (p<0.01). There were more women than men in both groups, but no statistical significance was observed. Hypertension, which was the most frequent comorbidity, was noticed in 96 (18.1%) patients. 40% of patients were of poor physical condition (ASA 3 and more) approximately. Regional anaesthesia was performed more frequently in the TKR group than in the THR group (p<0.01). The operations of knee replacement surgery lasted longer than hip replacement surgery (139.9+30.1min; p<0.01). All patients received thromboprophylactic drugs. Five patients (0.9%) who were in the THR group had prosthesis dislocation as one of the observed postoperative complication. The mean duration of hospitalization of patients in the TKR group was 29.7+24.7 days which was longer than in the THR group (p<0.01). CONCLUSION: Older population, especially women were operated on more frequently in the both groups. Regional anaesthesia was performed more frequently in the TKR group. Although a large percentage of patients had cardiovascular disorders and were of poor physical condition, postoperative complications were rare.

Anti-carbamylated Protein Antibodies and Serum Level of 14-3-3 Protein for Early Detection of Rheumatoid Arthritis Patient in Correlation with Rheumatoid Factor, Anti-CCP Antibodies, Disease Activity and Joint Damage using High Frequency Musculoskeletal Ultrasound

2020 ◽  
Vol 7 (2) ◽  
pp. 141-153
Author(s):  
Sahar A. Ahmed ◽  
Enas M. Darwish ◽  
Walaa A. Attya ◽  
Mai Samir ◽  
Mennatallah Elsayed ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Rheumatoid Factor ◽  
Disease Activity Score ◽  
Joint Damage ◽  
Musculoskeletal Ultrasound ◽  
Activity Score ◽  
Das 28 ◽  
Significant Difference ◽  
Hands And Feet

Background: Rheumatoid arthritis (RA) is a common progressive chronic inflammatory autoimmune disease which affects mostly small joints, causing pain, swelling, deformity, and disability. Although progress has been made in exploring RA nature, still there is a lot to know about the disease pathogenesis, diagnosis, and treatment. Aim of the Work: To investigate the role of serum anti-carbamylated protein antibodies and 14-3-3η in the diagnosis of RA compared to rheumatoid factor (RF), anti-CCP antibodies, and highfrequency musculoskeletal ultrasound used to assess the disease activity and joint damage. Methods: Serum anti-carbamylated protein antibodies and 14-3-3η were measured using ELISA in 61 RA patients and 26 normal controls. RA Disease Activity Score (DAS 28), X-ray and musculoskeletal ultrasound (hands and feet), carotid ultrasound (Intima-Media Thickness IMT) were used in assessing the RA disease. Results: Anti-carbamylated protein antibodies were significantly elevated in RA patients 4.5 (4.1- 8.9 U⁄ml) compared to the control 3.2(1.9- 4.3 U⁄ml) (p< 0.001) but 14-3-3η showed no significant difference. There was a significant positive correlation between anti-carbamylated protein antibodies, 14-3-3η levels and disease activity score assessed by DAS 28, increased IMT measured by carotid duplex, total synovitis and total erosion score were assessed by musculoskeletal ultrasound. There was no correlation between RF and anti-CCP antibodies. Anti-carbamylated protein antibodies were found to have 66.7% sensitivity and 85.2% specificity in RA diagnosis, while 14- 3-3η had 51.9% sensitivity and 72.1% specificity. Conclusion: Anti-carbamylated protein antibodies and 14-3-3η have a high sensitivity and specificity in RA diagnosis and had a correlation with the disease activity and joint damage.

A novel approach utilizing laser acupuncture teletherapy for management of elderly-onset rheumatoid arthritis: A randomized clinical trial

2021 ◽  
pp. 1357633X2110098
Author(s):  
Aya Sedky Adly ◽  
Afnan Sedky Adly ◽  
Mahmoud Sedky Adly ◽  
Mohammad F Ali
Keyword(s):  
Rheumatoid Arthritis ◽  
Virtual Reality ◽  
Elderly Patients ◽  
Aerobic Exercise ◽  
Health Professionals ◽  
Post Treatment ◽  
Laser Acupuncture ◽  
Virtual Reality Training ◽  
Significant Difference ◽  
Elderly Onset

Introduction Rheumatoid arthritis (RA) disease is a systemic progressive inflammatory autoimmune disorder. Elderly-onset RA can be assumed as a benign form of RA. Until recently, face-to-face therapeutic sessions between health professionals and patients are usually the method of its treatment. However, during pandemics, including coronavirus disease 2019 (COVID-19), teletherapeutic sessions can extensively increase the patient safety especially in elderly patients who are more vulnerable to these infections. Thus, the aim of this study was to evaluate a novel teletherapy approach for management of elderly patients suffering from RA by utilizing laser acupuncture. Methods A teletherapy system was used for management of elderly patients suffering from RA. Sixty participants were allocated randomly into two groups and the ratio was 1:1. Patients in the first group were treated with laser acupuncture and telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Patients in the second group received telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Evaluation of patients was done by using the Health Assessment questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire, and the analysis of interleukin-6 (IL-6), serum C-reactive protein (CRP), plasma adenosine triphosphate (ATP) concentration and plasma malondialdehyde (MDA). Results A statistically significant difference was found in CRP, RAQoL, IL-6 and MDA between the pre- and post-treatments in the first group ( p < 0.05) favouring the post-treatment group, while the HAQ showed a statistically significant difference between pre- and post-treatments ( p < 0.05) in both groups. Statistically significant post-treatment differences were also observed between the two groups ( p < 0.05) in RAQoL, CRP, ATP and MDA, favouring the first group. Discussion Laser acupuncture teletherapy could be suggested as a reliable treatment method for elderly patients suffering from RA, as it can provide a safe and effective therapeutic approach. Teletherapy provided safer access to health professionals and patients while giving a high patient satisfaction value with a relatively lower cost (ClinicalTrials.gov Identifier: NCT04684693).

scholarly journals POS1143 GOUT AND JOINT REPLACEMENTS IN THE US

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 851.1-851
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Knee Joint ◽  
Confidence Intervals ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Economic Burden ◽  
Hip Replacement ◽  
Average Charge ◽  
Joint Replacements ◽  
Increased Risk ◽  
The Us

Background:Irreversible joint damage in gout has been linked to a possible increase in knee and hip joint replacements1. In addition, the strong association between gout and osteoarthritis2,3 could also lead to an increased risk of joint replacements in patients with gout. Population-based data from the UK and Taiwan have shown hazard rates of 1.14 and 1.16 respectively for knee replacements in patients with gout compared to age and gender matched controls1. However, there is little national data in the US on clinical and economic burden of joint replacements in patients with gout.Objectives:To evaluate total or partial hip and knee joint replacements in patients with gout in the US and to estimate their economic impactMethods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Detailed information including clinical and nonclinical data elements on each hospital stay including International Classification of Diseases (ICD)10 diagnosis and procedure codes, age, gender, length of stay, payer, charges, comorbidities etc. is available. We examined hospitalizations in patients with gout with hip and knee joint replacements in NIS 2018, the most recent year of data.Results:In 2018, there were 914,510 hospitalizations with primary or secondary diagnosis of gout in the US. Of these 43,615 were for joint replacement surgeries (knee (24,840) and hip (18,755)). Patients with knee replacement were on an average 68.5 years old (95% confidence intervals 68.2 years -68.8 years). Patients with hip replacement were slightly older (mean age 70.3 years, 95% confidence intervals 69.8 years -70.7 years). Unlike general population statistics, men formed a majority of these joint replacements (68% for the knee and 72% for the hip). The average charge per hospitalization was $69,279 and $72,944 for knee and hip replacement respectively. The total annual national cost estimate was $3.09 billion, with government insurances (Medicare and Medicaid) responsible for 67% of knee replacement and 70% of hip replacement costs.Conclusion:Joint replacements in gout patients have a large clinical and economic burden in the US. This calls for an increased awareness and management of associated hip and knee arthritis in patients with gout.References:[1]Kuo CF, Chou IJ, See LC, et al. Urate-lowering treatment and risk of total joint replacement in patients with gout. Rheumatology. Dec 1 2018;57(12):2129-2139.[2]Howard RG, Samuels J, Gyftopoulos S, et al. Presence of gout is associated with increased prevalence and severity of knee osteoarthritis among older men: results of a pilot study. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases. Mar 2015;21(2):63-71.[3]Roddy E, Zhang W, Doherty M. Are joints affected by gout also affected by osteoarthritis? Annals of the rheumatic diseases. Oct 2007;66(10):1374-1377.Disclosure of Interests:Gurkirpal Singh Shareholder of: Pfizer, Merck, Sanofi, Grant/research support from: Horizon, Maanek Sehgal: None declared, Alka Mithal: None declared.

scholarly journals Association of biological antirheumatic therapy with risk for type 2 diabetes: a retrospective cohort study in incident rheumatoid arthritis

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e042246
Author(s):  
Sanjoy K Paul ◽  
Olga Montvida ◽  
Jennie H Best ◽  
Sara Gale ◽  
Attila Pethö-Schramm ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Type 2 Diabetes ◽  
T Cell ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Therapy ◽  
Treatment Groups ◽  
Significant Difference ◽  
Necrosis Factor

ObjectiveTo explore possible associations of treatment with biological disease-modifying antirheumatic drugs (bDMARDs), including T-cell-based and interleukin-6 inhibition (IL-6i)-based therapies, and the risk for type 2 diabetes mellitus (T2DM) in patients with rheumatoid arthritis (RA).Study design, setting and participantsFive treatment groups were selected from a United States Electronic Medical Records database of 283 756 patients with RA (mean follow-up, 5 years): never received bDMARD (No bDMARD, n=125 337), tumour necrosis factor inhibitors (TNFi, n=34 873), IL-6i (n=1884), T-cell inhibitors (n=5935) and IL-6i+T cell inhibitor abatacept (n=1213). Probability and risk for T2DM were estimated with adjustment for relevant confounders.ResultsIn the cohort of 169 242 patients with a mean 4.5 years of follow-up and a mean 641 200 person years of follow-up, the adjusted probability of developing T2DM was significantly lower in the IL-6i (probability, 1%; 95% CI 0.6 to 2.0), T-cell inhibitor (probability, 3%; 95% CI 2.3 to 3.3) and IL-6i+T cell inhibitor (probability, 2%; 95% CI 0.1 to 2.9) groups than in the No bDMARD (probability, 5%; 95% CI 4.6 to 4.9) and TNFi (probability, 4%; 95% CI 3.7 to 4.7) groups. Compared with No bDMARD, the IL-6i and IL-6i+T cell inhibitor groups had 37% (95% CI of HR 0.42 to 0.96) and 34% (95% CI of HR 0.46 to 0.93) significantly lower risk for T2DM, respectively; there was no significant difference in risk in the TNFi (HR 0.99; 95% CI 0.93 to 1.06) and T-cell inhibitor (HR 0.96; 95% CI 0.82 to 1.12) groups.ConclusionsTreatment with IL-6i, with or without T-cell inhibitors, was associated with reduced risk for T2DM compared with TNFi or No bDMARDs; a less pronounced association was observed for the T-cell inhibitor abatacept.

scholarly journals AB0655 RHEUMATOID ARTHRITIS ACTIVITY BEFORE AND AFTER COVID-19 LOCKDOWN PERIOD

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1360.1-1360
Author(s):  
M. Jordhani ◽  
D. Ruci ◽  
F. Skana ◽  
E. Memlika
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Musculoskeletal Diseases ◽  
Statistical Tests ◽  
Laboratory Data ◽  
World Population ◽  
Chronic Patients ◽  
Das 28 ◽  
Significant Difference ◽  
Before And After

Background:The COVID-19 global pandemic has had a great impact on world population due to morbidity, mortality and restriction measures in order to stop the progression of COVID-19.Patients with rheumatic and musculoskeletic diseases, and especially rheumatoid arthritis (RA) patients, being one of the vulnerable classes of chronic patients, were recommended to follow the government’s rules1.Objectives:The aim of this study was to evaluate DAS-28-ESR in patients with rheumatoid arthritis before and after lockdown period.Methods:This is a multi-center observational study including 85 patients which were evaluated before and after lockdown for their disease activity score according to DAS-28-ESR score. They had been diagnosed with rheumatoid arthritis more than 5 years ago. A thorough physical examination was performed before and after the lockdown period. It included examination of tender and swollen joints and patient’s global health. They were completed with all required laboratory data, including erythrosedimentation rate. For a more accurate calculation, DAS-28-ESR was used in an electronic version. Patients with other inflammatory or infective diseases were excluded from the study. All data were statistically evaluated using statistical tests such as t-student test.Results:The first group (the one before lockdown) had an average DAS-28-ESR of 4.7 while after the lockdown period, the average DAS-28-ESR was 5.16.After statistically evaluating all data, it was found that there exists a significant difference between DAS-28-ESR score before and after COVID-19 lockdown (p=0.0011).Conclusion:Our study showed that lockdown period due to COVID-19 pandemic, has aggravated disease activity in patients with Rheumatoid Arthritis. This may be consequence of various causes such as physical inactivity and difficulty to follow-up or to take the medication properly.References:[1]Landewé RB, Machado PM, Kroon F, et al, EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2, Annals of the Rheumatic Diseases 2020;79:851-858.Disclosure of Interests:None declared.

scholarly journals Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318694
Author(s):  
Dimitrios Venetsanos ◽  
Erik Träff ◽  
David Erlinge ◽  
Emil Hagström ◽  
Johan Nilsson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Similar Efficacy ◽  
Efficacy And Safety ◽  
Adjusted Risk ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Evidence Based Care

ObjectiveThe comparative efficacy and safety of prasugrel and ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) remain unclear. We aimed to investigate the association of treatment with clinical outcomes.MethodsIn the SWEDEHEART (Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies) registry, all patients with MI treated with PCI and discharged on prasugrel or ticagrelor from 2010 to 2016 were included. Outcomes were 1-year major adverse cardiac and cerebrovascular events (MACCE, death, MI or stroke), individual components and bleeding. Multivariable adjustment, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for confounders.ResultsWe included 37 990 patients, 2073 in the prasugrel group and 35 917 in the ticagrelor group. Patients in the prasugrel group were younger, more often admitted with ST elevation MI and more likely to have diabetes. Six to twelve months after discharge, 20% of patients in each group discontinued the P2Y12 receptor inhibitor they received at discharge. The risk for MACCE did not significantly differ between prasugrel-treated and ticagrelor-treated patients (adjusted HR 1.03, 95% CI 0.86 to 1.24). We found no significant difference in the adjusted risk for death, recurrent MI or stroke alone between the two treatments. There was no significant difference in the risk for bleeding with prasugrel versus ticagrelor (2.5% vs 3.2%, adjusted HR 0.92, 95% CI 0.69 to 1.22). IPTW and PSM analyses confirmed the results.ConclusionIn patients with MI treated with PCI, prasugrel and ticagrelor were associated with similar efficacy and safety during 1-year follow-up.

scholarly journals The radiological outcome in lumbar interbody fusion among rheumatoid arthritis patients: a 20-year retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kuan-Kai Tung ◽  
Yun-Che Wu ◽  
Kun-Hui Chen ◽  
Chien-Chou Pan ◽  
Wen-Xian Lu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interbody Fusion ◽  
Fusion Rate ◽  
Substantial Improvement ◽  
Lumbar Interbody Fusion ◽  
Subsidence Rate ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Cage Subsidence

Abstract Background Clinical outcomes amongst Rheumatoid Arthritis (RA) patients have shown satisfactory results being reported after lumbar surgery. The increased adoption of the interbody fusion technique has been due to a high fusion rate and less invasive procedures. However, the radiographic outcome for RA patients after receiving interbody fusion has scarcely been addressed in the available literature. Methods Patients receiving interbody fusion including ALIF, OLIF, and TLIF were examined for implant cage motion and fusion status at two-year follow-up. Parameters for the index correction level including ADH, PDH, WI, SL, FW, and FH were measured and compared at pre-OP, post-OP, and two-year follow-up. Results We enrolled 64 RA patients at 104 levels (mean 64.0 years old, 85.9% female) received lumbar interbody fusion. There were substantial improvement in ADH, PDH, WI, SL, FW, and FH after surgery, with both ADH and PDH having significantly dropped at two-year follow up. The OLIF group suffered from a higher subsidence rate with no significant difference in fusion rate when compared to TLIF. The fusion rate and subsidence rate for all RA patients was 90.4 and 28.8%, respectively. Conclusions We revealed the radiographic outcomes of lumbar interbody fusions towards symptomatic lumbar disease in RA patients with good fusion outcome despite the relative high subsidence rate amongst the OLIF group. Those responsible for intra-operative endplate management should be more cautious to avoid post-OP cage subsidence.

scholarly journals Effect of janus kinase inhibitors and methotrexate combination on malignancy in patients with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Vinod Solipuram ◽  
Akhila Mohan ◽  
Roshniben Patel ◽  
Ruoning Ni
Keyword(s):  
Rheumatoid Arthritis ◽  
Combination Therapy ◽  
Randomized Controlled Trials ◽  
Random Effect ◽  
Janus Kinase ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Significant Difference ◽  
Risk Of Malignancy

Abstract Background Rheumatoid arthritis (RA) is a systemic autoimmune disease. The combination therapy of methotrexate (MTX) and Janus kinase inhibitor (JAKi) is commonly used. Patients with RA are at increased risk of malignancy, however, it remains unclear whether the combination therapy is associated with a higher risk. Objective To assess the malignancy risk among patients with RA receiving combination therapy of JAKi and MTX compared to MTX alone. Methods PubMed, Cochrane and Embase were thoroughly searched for randomized controlled trials (RCTs) in patients with RA receiving JAKi and MTX, from inception to July 2020. Primary endpoints were malignancy events, Non melanomatous skin cancer (NMSC) and malignancy excluding NMSC and secondary endpoints were serious adverse events (SAE), deaths. Risk ratio (RR) and 95% CI were calculated using the Mantel–Haenszel random-effect method. Results 659 publications were screened and 13 RCTs with a total of 6911 patients were included in the analysis. There was no statistically significant difference in malignancy [RR = 1.42; 95% CI (0.59, 3.41)], neither NMSC [RR = 1.44 (0.36, 5.76)] nor malignancies excluding NMSC [RR = 1.12 (0.40, 3.13)]. No statistically significant difference between the two groups for SAE [RR = 1.15 (0.90, 1.47)] and deaths [RR = 1.99 (0.75, 5.27)] was found. Conclusion The adjunction of JAKi to MTX is not associated with an increased risk of malignancy when compared to MTX alone. There is no increased risk of SAE and deaths when compared to MTX alone in patients with RA.

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