Variability in the use of orthopedic surgery in patients with rheumatoid arthritis in Spain.
OBJECTIVE
To analyze sociodemographic and clinic-associated factors of patients with rheumatoid arthritis (RA) undergoing any orthopedic surgery (AOS) and total joint replacement (TJR) in Spain.


METHODS
A retrospective medical record review was performed in a probabilistic sample of 1379 RA patients from 46 centers distributed in 16 of 19 regions in Spain. Sociodemographic and clinical features, use of drugs, and arthritis-related joint surgeries were recorded following a standardized protocol. Gross domestic product (GDP) data were obtained from the National Statistical Index.


RESULTS
Of 1379 patients, a total of 358 (26%) underwent one or more joint surgeries, and 194 (14%) had a TJR. The median time to first orthopedic procedure was 12.5 years from presentation of RA and the estimated rate was 5.6 surgeries per 100 person-years. The rate of AOS was increased in women, patients with RA with extraarticular complications, with longterm RA (> 10 yrs), with functional grade III-IV, and with persistent inflammatory disease. The risk factors for undergoing a TJR were longterm RA, functional grade III-IV, and extraarticular complications. Patients from regions with higher GDP per capita were more likely to undergo a procedure.


CONCLUSIONS
Clinical variables reflecting disease activity and severity are predictors of orthopedic surgery, but geographic and socioeconomic variables were also independently associated with the rate of orthopedic surgery.
Loza
Estibaliz
E
Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, Spain.
Abásolo
Lydia
L
Clemente
Daniel
D
López-González
Ruth
R
Rodríguez
Luis
L
Vadillo
Cristina
C
Fernández-Gutiérrez
Benjamin
B
Macarrón
Pilar
P
Jover
Juan A
JA
Hernández-García
César
C
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000601:surgery*; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D013030:Spain