RT Journal Article
SR Electronic
T1 The Longterm Effect of Early Intensive Treatment of Seniors with Rheumatoid Arthritis: A Comparison of 2 Population-based Cohort Studies on Time to Joint Replacement Surgery
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.151156
DO 10.3899/jrheum.151156
A1 Jessica Widdifield
A1 Cristiano S.  Moura
A1 Yishu Wang
A1 Michal Abrahamowicz
A1 J. Michael  Paterson
A1 Anjie Huang
A1 Marie-Eve Beauchamp
A1 Gilles Boire
A1 Paul R.  Fortin
A1 Louis Bessette
A1 Claire Bombardier
A1 John G.  Hanly
A1 Debbie Feldman
A1 Sasha Bernatsky
A1 the CAnadian Network for Advanced Interdisciplinary Methods for comparative effectiveness research (CAN-AIM)
YR 2016
UL http://www.jrheum.org/content/early/2016/02/08/jrheum.151156.abstract
AB Objective Disease-modifying antirheumatic drugs (DMARD) have the greatest effect when initiated early. We evaluated the influence of early exposure to DMARD on time to joint replacement surgery among patients with incident rheumatoid arthritis (RA). Methods Using a common protocol, we undertook 2 independent population-based cohort studies of patients with incident RA aged 66 years or older in Ontario (ON) and Quebec (QC) covering the period 2000–2013. We used Cox proportional hazards regression with time-dependent variables measuring duration of drug use in the first year, separately for methotrexate (MTX) and other DMARD, adjusting for baseline demographics, clinical factors, and other potentially confounding drug exposures. Our outcome measure was any joint replacement derived from standardized procedure codes. Adjusted HR and 95% CI were estimated. Results Among 20,918 ON and 6754 QC patients with RA followed for a median of 4.5 years, 2201 and 494 patients underwent joint replacement surgery for crude event rates of 2.0 and 1.4 per 100 person-years, respectively. Greater cumulative exposure to MTX (HR 0.97, 95% CI 0.95–0.98) and other DMARD (HR 0.98, 95% CI 0.97–0.99) in the first year after diagnosis was associated with longer times to joint replacement in ON, corresponding to a 2–3% decrease in the hazard of surgery with each additional month of early use. Similar results were observed in QC. Conclusion Greater duration of exposure to DMARD soon after RA diagnosis was associated with delays to joint replacement surgery in both provinces. Early intensive treatment of RA may ultimately reduce demand for joint replacement surgery.