BREAKING NEWS - TNF Inhibitors Prevent Large Joint Replacements

X-rays in rheumatoid arthritis trials examine erosions and joint space narrowing in the hands and feet. Studies have shown that the number of small joint surgeries was reduced after the introduction of TNF inhibitors. However, it has been difficult to find data suggesting that there are reductions of large joint replacements (hips and knees).

A national Danish health register was used to evaluate whether the rate of large joint replacements was changing over time in RA patients (N>30,000) vs. the general population. Cordtz R, et al. EULAR 2017, Madrid (OP0251) reported that prior to 2002, total knee replacement (TKR) increased among RA patients, but decreased after the introduction of bDMARDs relative to the general population where there was a steady increase in TKR over time. Similarly, total hip replacements decreased in RA over time. In other words, large joint surgeries (hip and knee replacements) are now relatively less common in RA patients compared to controls.

Another study, the large Canadian early RA cohort (CATCH), showed that large tender joints have the greatest impact on function based on a trajectory analysis (Lim L, et al. SAT0039). HAQ is a measure of patient self-reported functional impairment and it includes more questions for the upper extremities than for the lower extremities, so I would have thought that small joints of the hands (and likely the shoulders) would impair function and drive HAQ scores. I also would have thought that swollen joints were more likely to cause functional impairment than tender joints. But I was wrong. 

Tender joints affect HAQ more thans swollen joints, and large joints affect HAQ more than small ones. One tender large joint affects HAQ six to nine times more than one tender small joint of the hands or feet. So, pay attention to tender large joints in early RA.

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Trending Reports From EULAR 2017