title: What is the risk of having a total hip or knee replacement for patients with lupus?
abstract: Individuals with systemic lupus erythematosus (SLE) frequently have arthralgia but joint damage leading to surgery is thought to be less common. In addition to inflammatory damage, other reasons like avascular necrosis (AVN), which is often associated with steroid use, excessive alcohol intake and antiphospholipid syndrome (APS), may increase the likelihood of large joint failure. In this study we aimed to determine the likelihood of having a total hip replacement (THR) or total knee replacement (TKR) for individuals with SLE compared to those without lupus, by performing a retrospective matched case control study of all THRs and TKRs that were performed between 1991 and 2011 and recorded in the General Practice Research Database (GPRD). Individuals with inflammatory arthritis due to any other causes were excluded and the results were adjusted for steroid use, alcohol consumption (drinking status) and APS. The results show that patients with lupus who had a THR or TKR were younger than their peers without lupus. In addition, they appeared to have a significantly increased risk of TKR but the increased risk of THR did not remain after adjustment for steroid use, alcohol consumption and APS.
authors.affiliation: NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, UK sandeep.mukherjee@nhs.net.
authors.forename: S
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: Faculty of Medicine, University of Southampton, UK.
authors.forename: D
authors.initials: D
authors.lastname: Culliford
authors.affiliation: NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, UK Faculty of Medicine, University of Southampton, UK Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK.
authors.forename: N
authors.initials: N
authors.lastname: Arden
authors.affiliation: NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, UK Faculty of Medicine, University of Southampton, UK Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Edwards
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012306:Risk
keywords: Systemic lupus erythematosus; arthroplasty; hip; knee; replacement