This paper aims to study the prevalence of total knee and hip replacements in Greek patients with rheumatoid arthritis (RA) and to identify possible predictive factors for future total hip or knee replacement.
A retrospective medical record review was performed in 750 RA patients who were recruited during 1994 to 2008 in a single Greek medical centre. Of the reviewed patients, 489 with a minimum follow-up duration of 1 year were enrolled in the study. The occurrence of total hip or knee replacement was used as the primary outcome variable in the predictive analysis.
Total hip or knee replacement associated with RA was performed in 21 patients (4.3%). Total disease duration was the most significant factor associated with increased likelihood of total joint replacement. Erythrocyte sedimentation rate (ESR) at baseline examination was positively associated with subsequent knee or hip joint replacement (OR=1.023, 95%CI 1.005-1.04). Inadequate response to treatment was associated with a 3.12-times higher likelihood of joint replacement (95%CI, 1.28-7.58). The patients who underwent total hip or knee replacement had significantly higher ESRs and DAS 28 levels (p<0.046 and p<0.002, respectively) after the first year of follow-up.
The identification of factors associated with total joint hip or knee replacement can improve pharmacological treatment to maintain function and prevent destruction of the affected joints. Longer disease duration and inadequate response to treatment after the first year of follow-up increases the likelihood ratio for total joint replacement during the course of disease in Greek RA patients.