title: Variability in the use of orthopedic surgery in patients with rheumatoid arthritis in Spain.
abstract: 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.
authors.affiliation: Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Loza
authors.forename: Lydia
authors.initials: L
authors.lastname: Abásolo
authors.forename: Daniel
authors.initials: D
authors.lastname: Clemente
authors.forename: Ruth
authors.initials: R
authors.lastname: López-González
authors.forename: Luis
authors.initials: L
authors.lastname: Rodríguez
authors.forename: Cristina
authors.initials: C
authors.lastname: Vadillo
authors.forename: Benjamin
authors.initials: B
authors.lastname: Fernández-Gutiérrez
authors.forename: Pilar
authors.initials: P
authors.lastname: Macarrón
authors.forename: Juan A
authors.initials: JA
authors.lastname: Jover
authors.forename: César
authors.initials: C
authors.lastname: Hernández-García
mesh_terms: 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