Abstract
BACKGROUND: Treatment of patients with rheumatoid arthritis (RA) has improved markedly over the past 25 years. OBJECTIVE: To investigate whether rates of joint surgery, a long-term consequence of poorly controlled RA, have changed over this period. METHODS: In this population-based, serial cross-sectional study of patients with RA aged >or=40 years in California, trends in annual rates of total knee arthroplasty, total hip arthroplasty, total ankle arthroplasty or arthrodesis and total wrist arthroplasty or arthrodesis from 1983 to 2007 were examined. RESULTS: Rates of joint surgery peaked in the 1990 s and since have decreased. Among patients aged 40-59 years, rates of knee surgery in 2003-2007 were 19% lower than in 1983-1987 (adjusted rate ratio 0.81; 95% CI 0.74 to 0.87, p<0.0001), while rates of hip surgery in 2003-2007 were 40% lower (p<0.0001). Rates of knee and hip surgery did not decrease in patients aged >or=60 years but increased as observed in the general population. Compared with rates of ankle and wrist surgery in the mid-1980s, rates in the mid-2000s decreased significantly in both age groups. CONCLUSIONS: Rates of joint surgery in RA peaked in the 1990 s and have declined thereafter, suggesting that longterm outcomes of RA are improving.