类风湿关节炎与人工关节置换究竟相关几何？

来源：骨科在线orthonline

近期发表于《J Arthroplasty》杂志的一项包含65,898名患者的12年回顾性队列研究表明，与非类风湿关节炎（RA）患者相比，RA患者进行全膝和髋关节置换术（TKA和THA）的长期风险要高4.02倍。

RA是一种炎症性疾病，会引起关节周围软组织和软骨的破坏。由于强效的抗风湿病药物的广泛使用，RA患者的THA或TKA的需求已减少。然而，RA与THA或TKA之间的关联尚未在大规模的流行病学研究中得到证实。因此作者设计了一项大规模回顾性队列研究，以证明RA与人工关节置换的关系。

研究人员对中国台湾12年（2000-2012年）诊断为RA的患者进行了大规模回顾性队列研究，共招募了32,949名RA患者和32,949名倾向性评分匹配的非RA患者作为对照。

结果显示，在调整了混杂因素后，RA患者行THA或TKA的风险是非RA患者的4.02倍（95％置信区间[CI]，3.77-4.52）。年龄小于40岁的RA患者中THA或TKA的风险最高（调整后的风险比为43.18；95％CI为16.01-116.47）。与非RA患者相比，RA患者行THA的可能性高4.82倍（95％CI，3.84-6.04），行TKA的可能性高3.85倍（95％CI，3.48-4.25），同时接受THA和TKA的可能性高19.06倍（95％CI，8.90-40.80）。

原文摘要

Risk of Total Knee and Hip Arthroplasty in Patients With Rheumatoid Arthritis: A 12-Year Retrospective Cohort Study of 65,898 Patients

Background:

Rheumatoid arthritis (RA) is an inflammatory disease that causes the destruction of soft tissues and cartilage around joints. Owing to the widespread use of potent disease-modifying antirheumatic drugs, the need for total knee and hip arthroplasties (TKA and THA) has been reduced in patients with RA. However, the current association between RA and either THA or TKA has not been demonstrated in large-scale epidemiological studies.

Methods:

We conducted a large-scale retrospective cohort study of patients diagnosed with RA during a 12-year period (2000-2012) in Taiwan. We recruited 32,949 patients with RA and 32,949 individually propensity score-matched non-RA controls.

Results:

After adjusting for confounding factors, we found that the risk of THA or TKA was 4.02 times higher in patients with RA than in those without RA (95% confidence interval [CI], 3.77-4.52). The risk of THA or TKA was highest in patients with RA younger than 40 years (adjusted hazard ratio, 43.18; 95% CI, 16.01-116.47). Compared with non-RA patients, patients with RA were 4.82 times more likely to undergo THA (95% CI, 3.84-6.04), 3.85 times more likely to undergo TKA (95% CI, 3.48-4.25), and 19.06 times more likely to undergo both THA and TKA (95% CI, 8.90-40.80).

Conclusion:

These findings document a 4.02-fold greater long-term risk of undergoing THA or TKA in RA patients relative to non-RA patients in Taiwan.

文献出处

Lee YH, Ko PY, Kao SL, Lin MC, Cheng-Chung Wei J. Risk of Total Knee and Hip Arthroplasty in Patients With Rheumatoid Arthritis: A 12-Year Retrospective Cohort Study of 65,898 Patients [published online ahead of print, 2020 Jul 3]. J Arthroplasty. 2020;S0883-5403(20)30750-6. doi:10.1016/j.arth.2020.06.085