title: Profound reduction in hospital admissions and musculoskeletal surgical procedures for rheumatoid arthritis with concurrent changes in clinical practice (1995-2010).
abstract: OBJECTIVE
  The aims of this study were to audit the annual national incidence of inpatient days and musculoskeletal surgical procedures (MSKSPs) for RA patients and to establish concurrent changes in clinical rheumatology practice from 1995 to 2010.
  
  
  METHODS
  Hospital inpatient enquiry systems were evaluated for 57 hospitals from 1995 to 2010. National annual TNF inhibitor (TNFi) and MTX prescriptions were analysed. Trends were analysed by logistic regression and correlations by Spearman's rho.
  
  
  RESULTS
  Fifty-four thousand eight hundred and six RA inpatient records were reviewed from 1995 to 2010 [70% female, mean age 66 years (s.d. 16)]. RA inpatient days decreased from 53 671 in 1995 to 29 000 in 2010 (r(2) = 0.8, P < 0.0001). Inpatient MSKSPs for RA patients decreased from a peak of 370 in 1996 to 188 in 2010 (r(2) = 0.7, P < 0.0001). Knee and hip replacements for the general population annually increased over the past 15 years, yet there was a significant decrease in the annual ratio of hip arthroplasties and knee arthroplasties for RA patients compared with those done for the general population from 1995 to 2010 (r(2) = 0.6, P < 0.001 and r(2) = 0.8, P < 0.01, respectively). Annual national TNFi prescriptions increased from 2389 units in 2000 to 116 747 in 2010. Concurrently MTX prescriptions increased nationally from 3300 in 2001 to 9600 in 2010. During the same period there was an increase in rheumatologists from 15 to 40 and in orthopaedic surgeons from 64 to 88.
  
  
  CONCLUSIONS
  Elective MSKSPs for RA patients have almost halved over the past 15 years, despite an increase in hip and knee arthroplasties for the general population, along with an almost halving of inpatient days for RA patients.
authors.affiliation: Department of Rheumatology and Department of Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland. lenharty@yahoo.com.
authors.forename: Len
authors.initials: L
authors.lastname: Harty
authors.affiliation: Department of Rheumatology and Department of Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Gary
authors.initials: G
authors.lastname: O'Toole
authors.affiliation: Department of Rheumatology and Department of Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Oliver
authors.initials: O
authors.lastname: FitzGerald
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D019644:Arthroplasty, Replacement, Hip / Q000639:trends; D019645:Arthroplasty, Replacement, Knee / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000639:trends*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012219:Rheumatology / Q000639:trends*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate
keywords: MTX; TNFi; co-morbidities; hip; knee; orthopaedics; outcomes; rheumatoid arthritis; surgery