Rheumatoid arthritis

RA doubles risk of death after joint surgery

RA are almost twice as likely to die following joint surgery, than the general population, a new study has revealed.

And the risk continues for as long as 12 months post-surgery, with the RA group having “significantly higher odds of MI, all-cause death and CV death compared to those without RA,” adding a further burden to the disease.

However, one of the senior authors, leading rheumatologist Associate Professor Sharon Van Doornum, said the findings should not deter RA patients from joint surgery.

The authors of the study, published in the Arthritis and Research Therapy journal, said that while further studies were needed to determine the contribution of subclinical cardiovascular disease, RA disease severity, functional status and RA treatments to this increased mortality, it was useful information for clinicians and patients alike.

“Understanding the risks of postoperative MI and mortality can help patients with RA make informed decisions about undergoing joint surgery procedures,” the authors of the large population-based study wrote.

The association between RA and increased risk of MI and post-MI fatality is not new, and a previous study by the same investigators examining post-MI treatment in RA compared with controls has noted a higher proportion of RA patients experiencing MI following a surgical procedure.

But this study was much larger and delved deeper by looking at the risk of MI and mortality at 6 weeks and 12 months following joint surgery in patients with RA compared with the general population.

Professor Doornum, said that the increased post-operative risk was present both in the early post-operative period and over the long term as well, and that it was present even in individuals who underwent relatively minor joint operations.

“The observed result is unlikely to be solely related to the joint surgery and the increased overall risk of cardiovascular disease in RA patients is likely to be a significant contributing factor,” she told the limbic.

This study drew from 10 years of hospital administrative data for all types of joint surgery within a single Australian state and included outcome information for 308,589 procedures, including 3654 involving patients with RA.

Researchers conceded that the growing use of biological disease-modifying anti-rheumatic drugs, had reduced the incidence of joint surgery and long-term prognosis has been improving for people with RA, and this would likely impact risks.

Professor Van Doornum said the study results should not dissuade RA patients who need joint surgery from going ahead but highlighted the need for careful pre-operative screening for, and management of, cardiac risk factors or cardiac disease. “Close post-operative monitoring of cardiac function and early intervention in the event of cardiac symptoms in RA patients following joint surgery is also imperative,” she said.

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