title: Hospitalization for musculoskeletal disorders in rheumatoid arthritis patients: a population-based study.
abstract: Rheumatoid arthritis (RA) patients failing disease modifying antirheumatic drugs (DMARDs) may undergo anti-Tumor Necrosis Factor (anti-TNF) therapy. Using the Quebec health services administrative databases, we examined the rates of musculoskeletal (MSD)-related hospitalizations among RA patients receiving anti-TNF, DMARDs, and neither of those therapies (non-users).
  
  
  
  Matched cohort analyses were performed separately in 2002-2006 and 2007-2011. In each cohort, DMARD and non-user groups were formed to 3-1 match the anti-TNF users on age, sex, date of RA diagnosis, high-dimensional propensity score and date of the first anti-TNF dispensation (index-date). Non-users did not use DMARDs or anti-TNF drugs during the year before the index-date and in the 90 days post, but used at least one of these medications in the study period.
  
  
  
  During 2002-2006, 557 anti-TNF users were matched to 1144 DMARD users and to 656 non-users, compared to 690, 1651, and 532 patients, respectively during 2007-2011. The crude rates of MSD-related hospitalizations in the anti-TNF, DMARD and non-users groups were respectively: 8.2/100, 6.4/100 and 10.5/100 patient-years in 2002-2006, and 6.9/100, 4.8/100, and 8.6/100 patient-years in 2007-2011. In multivariable Cox regression models, the hazard ratios of MSD-related hospitalizations (95 % confidence interval) were: 0.95 (0.60; 1.50) for anti-TNF and 0.69 (0.46; 1.02) for DMARD users, versus non-users in 2002-06, and 0.65 (0.37; 1.14) and 0.40 (0.24; 0.66), respectively in 2007-2011.
  
  
  
  The MSD-related hospitalization risk was lower in RA patients using DMARD therapy and similar in those using anti-TNF therapy with or without DMARDs as compared to those not using either of these therapies during the study period.
authors.affiliation: Research Institute of the McGill University Health Centre, Montreal, QC, Canada.|College of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Marina Amaral de Ávila
authors.initials: MA
authors.lastname: Machado
authors.affiliation: Research Institute of the McGill University Health Centre, Montreal, QC, Canada.|Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Ave West, V building, Montreal, QC, H3A 1A1, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, QC, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Bessette
authors.affiliation: Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Hacene
authors.initials: H
authors.lastname: Nedjar
authors.affiliation: Research Institute of the McGill University Health Centre, Montreal, QC, Canada. elham.rahme@mcgill.ca.|Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Ave West, V building, Montreal, QC, H3A 1A1, Canada. elham.rahme@mcgill.ca.
authors.forename: Elham
authors.initials: E
authors.lastname: Rahme
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF; DMARDs; Musculoskeletal conditions; Rheumatoid arthritis