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Rheumatology Advance Access published online on February 22, 2008
Rheumatology, doi:10.1093/rheumatology/ken009
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Decrease of RA-related orthopaedic surgery of the upper limbs between 1998 and 2004: data from 54 579 Swedish RA inpatients

R. J. Weiss1, A. Ehlin2, S. M. Montgomery2,3, M. C. Wick4, A. Stark1 and P. Wretenberg1

1Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, 2Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet/Karolinska University Hospital, Stockholm, 3Clinical Research Centre, Örebro University Hospital, Örebro and 4Department of Medicine, Section of Rheumatology, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden.

Correspondence to: R. J. Weiss, Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet/Karolinska University Hospital, S-171 76 Stockholm, Sweden. E-mail: rudiger.weiss{at}karolinska.se


  Abstract

Objectives. To describe the overall use and temporal trends in orthopaedic upper limb surgery associated with RA on a nation wide basis in Sweden between 1998 and 2004.

Methods. Data for all inpatient visits during 1998–2004 for patients older than 18 yrs with RA-related diagnoses were extracted from the Swedish National Hospital Discharge Registry (SNHDR). The SNHDR prospectively collects data on all hospital admissions in Sweden according to the International Classification of Diseases (ICD). Data were analysed with respect to orthopaedic surgery of the hand, elbow and shoulder.

Results. During the study period, 54 579 individual RA patients were admitted to a Swedish hospital and 9% of these underwent RA-related surgery of the upper limbs. The RA patient cohort underwent a total of 8251 RA-related upper limb surgical procedures. The hand (77%) was most frequently operated on, followed by the shoulder (13%) and the elbow (10%). There was a statistically significant decrease of 31% for all admissions associated with RA-related upper limb surgery during 1998–2004 (P = 0.001). Some 10% of all RA-related upper limb surgery was due to total joint arthroplasties (TJAs), mostly for the elbow (59%). During 1998–2004, all TJAs, elbow-TJAs and shoulder-TJAs had a stable occurrence. In contrast, the overall numbers of hand-TJAs significantly increased (P = 0.009).

Conclusions. Rates of RA-related upper limb surgery decreased and TJAs had a stable occurrence in Sweden during 1998–2004. The findings of this study may reflect trends in disease management and health outcomes of RA patients in Sweden.

KEY WORDS: Epidemiology, Orthopaedic surgery, Rheumatoid arthritis, Upper limbs

Submitted 25 July 2007; revised version accepted 4 January 2008.
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