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Research ArticleSpondyloarthritis/Psoriatic Arthritis

Relation of NSAIDs, DMARDs, and TNF Inhibitors for Ankylosing Spondylitis and Psoriatic Arthritis to Risk of Total Hip and Knee Arthroplasty

Rachael Stovall, Christine Peloquin, David Felson, Tuhina Neogi and Maureen Dubreuil
The Journal of Rheumatology July 2021, 48 (7) 1007-1013; DOI: https://doi.org/10.3899/jrheum.200453
Rachael Stovall
1R. Stovall, Internal Medicine Resident, MD, Boston University Medical Center, Boston, Massachusetts;
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Christine Peloquin
2C. Peloquin, Statistical Manager, MPH, D. Felson, Professor of Medicine and Epidemiology, MD, MPH, T. Neogi, Professor of Medicine, MD, PhD, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts;
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David Felson
2C. Peloquin, Statistical Manager, MPH, D. Felson, Professor of Medicine and Epidemiology, MD, MPH, T. Neogi, Professor of Medicine, MD, PhD, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts;
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Tuhina Neogi
2C. Peloquin, Statistical Manager, MPH, D. Felson, Professor of Medicine and Epidemiology, MD, MPH, T. Neogi, Professor of Medicine, MD, PhD, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts;
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Maureen Dubreuil
3M. Dubreuil, Assistant Professor of Medicine, MD, MSc, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, and OptumLabs Visiting Scholar, OptumLabs, Eden Prairie, Minnesota, USA.
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  • For correspondence: mdubreui@bu.edu
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  • Errata - December 01, 2021

Abstract

Objective. Ankylosing spondylitis (AS) and psoriatic arthritis (PsA) often affect the hip and/or knee. If effective, treatments might reduce risk of total hip or total knee arthroplasty (THA/TKA). We evaluated risk of THA/TKA related to use of medical therapies in AS/PsA.

Methods. We conducted a nested case-control study using 1994–2018 data from the OptumLabs Data Warehouse, which includes deidentified medical and pharmacy claims, laboratory results, and enrollment records for commercial and Medicare Advantage enrollees. Among those with AS/PsA, THA/TKA cases were matched up to 4 controls by sex, age, AS/PsA diagnosis, diagnosis year, insurance type, obesity, and prior THA/TKA. We assessed AS/PsA treatment 6 months prior to THA/TKA, including disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor inhibitors (TNFi), alone or in combination, stratified by nonsteroidal antiinflammatory drug (NSAID) use. We evaluated the relation of treatment to risk of THA/TKA using conditional logistical regression with adjustment for confounders.

Results. Among 16,748 adults with AS, there were 444 THA/TKA cases and 1613 matched controls. Among 34,512 adults with PsA, there were 1003 cases and 3793 controls. Adjusted ORs for treatment category and THA/TKA ranged from 0.60 to 1.92; however, none were statistically significant. Results were similarly null in several sensitivity analyses.

Conclusion. Odds of THA/TKA were not reduced with any combinations of NSAIDs, DMARDs, or TNFi among persons with AS or PsA. Given current utilization patterns in this population of US adults with AS and PsA, these medical therapies did not appear to be associated with less end-stage peripheral joint damage.

Key Indexing Terms:
  • ankylosing spondylitis
  • psoriatic arthritis
  • total hip arthroplasty
  • total knee arthroplasty
  • tumor necrosis factor inhibitors
  • Accepted for publication January 5, 2021.
  • Copyright © 2021 by the Journal of Rheumatology
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Relation of NSAIDs, DMARDs, and TNF Inhibitors for Ankylosing Spondylitis and Psoriatic Arthritis to Risk of Total Hip and Knee Arthroplasty
Rachael Stovall, Christine Peloquin, David Felson, Tuhina Neogi, Maureen Dubreuil
The Journal of Rheumatology Jul 2021, 48 (7) 1007-1013; DOI: 10.3899/jrheum.200453

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Relation of NSAIDs, DMARDs, and TNF Inhibitors for Ankylosing Spondylitis and Psoriatic Arthritis to Risk of Total Hip and Knee Arthroplasty
Rachael Stovall, Christine Peloquin, David Felson, Tuhina Neogi, Maureen Dubreuil
The Journal of Rheumatology Jul 2021, 48 (7) 1007-1013; DOI: 10.3899/jrheum.200453
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Keywords

ANKYLOSING SPONDYLITIS
PSORIATIC ARTHRITIS
TOTAL HIP ARTHROPLASTY
TOTAL KNEE ARTHROPLASTY
TUMOR NECROSIS FACTOR INHIBITORS

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Keywords

  • ankylosing spondylitis
  • psoriatic arthritis
  • total hip arthroplasty
  • total knee arthroplasty
  • tumor necrosis factor inhibitors

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