Fewer Hospitalizations for Rheumatoid Arthritis
April 28, 2004
By Stephanie Riesenman for Knee1
There have been fewer hospitalizations for rheumatoid arthritis since the early 1980’s, according to a new study, and doctors suggest more widespread use of disease modifying drugs may be helping to slow the disease’s progression and therefore decrease the need for surgery.
"Recently, the findings from several...studies have suggested that treatment with disease-modifying medications initiated early in the course of [rheumatoid arthritis] leads to improved control of joint inflammation, less joint damage, and better health," wrote Dr. Michael Ward, of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.
His study on the decreasing trend of hospitalizations for rheumatoid arthritis was published in the current issue of Arthritis and Rheumatism.
Rheumatoid arthritis is an inflammatory disease that can affect any joint in the body. Patients experience redness in the joints, along with warmth and swelling, which ultimately leads to a loss of joint function.
The cause of rheumatoid arthritis is unknown, but it’s understood that symptoms occur as a result of activation of the immune and inflammatory systems. Doctors believe the disease is triggered by environmental factors in people who are predisposed to rheumatoid arthritis.
There is no cure, but it’s now well documented that catching the disease early and starting medications in the beginning stages significantly reduces joint damage. Some of those medications include methotrexate and anti-Tumor Necrosis Factor drugs such as Remicade and Enbrel.
In order to assess the long-term health outcomes associated with changes in treatment strategies for rheumatoid arthritis, Dr. Ward and his colleagues gathered health records from a computer database in California for all patients admitted to hospitals with 4 different symptoms of rheumatoid arthritis between the years of 1983 to 2001. Data was analyzed on patients older than 40 years. Most of the hospitalized patients were white women.
Patients’ records were admitted into the study if they had any of the 4 diagnoses: rheumatoid vasculitis (inflammation of the blood vessels), splenectomy for treatment of Felty’s syndrome (enlarged spleen and low white blood count), cervical fusion for treatment of myelopathy, and total knee replacement.
Dr. Ward found that the rate of hospitalization for vasculitis decreased from 170 per 100,000 persons with rheumatoid arthritis in 1983 to 99 per 100,000 persons in 2001—a decrease of 33 percent. Splenectomy rates decreased by 71 percent during the same period—from 8 per 100,000 persons to 1 per 100,000 persons with rheumatoid arthritis.
There was no significant reduction in the rate of hospitalizations for cervical spine surgery, although the results trended towards a decline in the number of procedures.
Rates of hospitalization for knee replacements actually increased from 1983 to 1997, but then the numbers decreased from 1997 to 2001. The number of knee surgeries performed from 1997 to 2001 was not significantly different from the number of procedures performed during 1983 to 1987.
"The decrease in the rates of knee arthroplasties is particularly noteworthy," wrote Dr. Ward, "given that rates of this procedure among Medicare recipients have more than doubled from 1988 to 2000."
It’s important to point out, that although the decrease in hospitalizations occurred during a time when the use of disease-modifying drugs was on the rise, this study did not collect data on the patients’ use of these types of drugs during the study period. Therefore, a direct association between medication use and changes in severity of rheumatoid arthritis cannot be made.
But Dr. Ward believes that as the use of anti-rheumatic drugs becomes more prevalent, and the medications are used more consistently throughout the course of the disease, patients can expect less physical disability, a decreased need for joint surgery, and further decreases in excess mortality.