Two new papers presented June 13 at the 2018 Annual European Congress of Rheumatology conference in Amsterdam spell good news for rheumatoid arthritis patients when it comes to joint replacements. In the first, researchers found that joint replacements decreased by more than half in RA patients between 1997 and 2010. And in the second study, researchers examined the role biological therapy has played in that decrease.

“We welcome these results demonstrating such a dramatic reduction of joint replacements in
RA patients in recent years,” said Robert Landewé, chairman of the EULAR scientific program committee, in a release. “It’s also very interesting to see data relating specifically to the impact of biological treatments on this outcome given the breadth of progress in the management of RA over the same time period.”

Chris Skedgel, of Dalhousie University in Canada, and colleagues found that the number of RA patients increased among a cohort of about 1 million from 3,913 to 4,911 over the course of the study. Although joint replacements were more common among the RA patients than those who didn’t have RA, joint replacements decreased by 51.9 percent among RA patients from 1997 to 2010. “This was in contrast to controls in whom the frequency of procedures increased by 31.9 percent with the exception of hip arthroplasty,” Skedgel and colleagues wrote. They called the reduction in RA patients “striking,” and concluded “Improvement in medical treatment of RA is likely responsible.”

In the second study, Samuel Hawley, of Oxford, and colleagues found that the use of biologics, particularly tumour necrosis factor inhibitors, doesn’t account for the reduction in joint replacements among younger and less severe RA patients. And although TNFi might be responsible for the reduction in hip replacements among certain patients, it didn’t impact the lower rates in knee or other joint replacements.

“The use of biologic therapies has been routinely offered as an explanatory factor for the
reduction in rates of joint replacement over recent years,” Hawley said in the release. “Our study offers some support for this in that a reduction in hip replacement procedures was observed in older patients on TNFi, although our results also suggest additional factors are likely to be involved. For example, the drive for earlier diagnosis/treatment and increased prescription rates of conventional synthetic disease-modifying antirheumatic drugs.”

“It’s important to highlight that we used an observational study design and that despite our best efforts to address confounding factors, these may still partly explain our findings,” he added.