title: Can Rheumatologists Predict Eventual Need for Orthopaedic Intervention in Patients with Rheumatoid Arthritis? Results of a Systematic Review and Analysis of Two UK Inception Cohorts.
abstract: OBJECTIVE
  The structural damage caused by rheumatoid arthritis (RA) can often be mitigated by orthopaedic surgery in late disease. This study evaluates the value of predictive factors for orthopaedic intervention.
  
  
  METHODS
  A systematic review of literature was undertaken to identify papers describing predictive factors for orthopaedic surgery in RA. Manuscripts were selected if they met inclusion criteria of cohort study design, diagnosis of RA, follow-up duration/disease duration ≥3 years, any orthopaedic surgical interventions recorded, and then summarised for predictive factors. A separate predictive analysis was performed on two consecutive UK Early RA cohorts, linked to national datasets.
  
  
  RESULTS
  The literature search identified 15 reports examining predictive factors for orthopaedic intervention, 4 inception, 5 prospective and 6 retrospective. Despite considerable variation, acute phase, x-ray scores, women and genotyping were the most commonly reported prognostic markers. The current predictive analysis included 1602 procedures performed in 711 patients (25-year cumulative incidence 26%). Earlier recruitment year, erosions and lower haemoglobin predicted both intermediate and major surgery (P<0.05). Studies report variations in type of and predictive power of clinical and laboratory parameters for different surgical interventions suggesting specific contributions from different pathological and/or patient-level factors. Our current analysis suggests that attention to non-inflammatory factors in addition to suppression of inflammation is needed to minimise the burden of orthopaedic surgery.
authors.affiliation: ERAS, Department of Rheumatology, St Albans City Hospital, St Albans, UK.|Academic Rheumatology Department, King's College London, London, UK.|Whittington Hospital NHS Trust, London, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Nikiphorou
authors.affiliation: Whittington Hospital NHS Trust, London, UK.
authors.forename: Lewis
authors.initials: L
authors.lastname: Carpenter
authors.affiliation: Health Psychology Section, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.affiliation: Academic Rheumatology Department, King's College London, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.affiliation: Institute of Musculoskeletal Science, University College London, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: MacGregor
authors.affiliation: Department of Rheumatology, New Cross Hospital, Wolverhampton, UK.
authors.forename: Josh
authors.initials: J
authors.lastname: Dixey
authors.affiliation: Department of Rheumatology, Medway Maritime Hospital, Gillingham, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Williams
authors.affiliation: Department of Rheumatology, St Georges Healthcare Trust, London, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kiely
authors.affiliation: Arthritis UK Pain Centre, University of Nottingham, Nottingham, UK.
authors.forename: David Andrew
authors.initials: DA
authors.lastname: Walsh
authors.affiliation: ERAS, Department of Rheumatology, St Albans City Hospital, St Albans, UK. adam.young@nhs.net.|Whittington Hospital NHS Trust, London, UK. adam.young@nhs.net.
authors.forename: Adam
authors.initials: A
authors.lastname: Young
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000601:surgery*; D018450:Disease Progression; D006801:Humans; D064887:Observational Studies as Topic; D019637:Orthopedic Procedures / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors
keywords: Orthopaedic surgery; Outcome measures; Predictors; Rheumatoid arthritis; Total joint replacement