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Arthritis Res Ther. 2015 Aug 3;17:197. doi: 10.1186/s13075-015-0713-3.

Early medication use in new-onset rheumatoid arthritis may delay joint replacement: results of a large population-based study.

Author information

1
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. cristiano.soaresdemoura@mail.mcgill.ca.
2
Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building (V2.09), Montreal, QC, H3A 1A1, Canada. cristiano.soaresdemoura@mail.mcgill.ca.
3
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. michal.abrahamowicz@clinepi.mcgill.ca.
4
Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building (V2.09), Montreal, QC, H3A 1A1, Canada. michal.abrahamowicz@clinepi.mcgill.ca.
5
Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building (V2.09), Montreal, QC, H3A 1A1, Canada. marie-eve.beauchamp@clinepi.mcgill.ca.
6
Department of Medicine, University of British Columbia, Vancouver, BC, Canada. dlacaille@arthritisresearch.ca.
7
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. yishu.wang@mail.mcgill.ca.
8
Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada. gilles.boire@usherbrooke.ca.
9
Division of Rheumatology, Department of Medicine, Université Laval, Quebec City, QC, Canada. paul.fortin@crchudequebec.ulaval.ca.
10
Division of Rheumatology, Department of Medicine, Université Laval, Quebec City, QC, Canada. louis.bessette@crchudequebec.ulaval.ca.
11
Division of Rheumatology, University of Toronto, Toronto, ON, Canada. claire.bombardier@utoronto.ca.
12
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. jessica.widdifield@utoronto.ca.
13
Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada. john.hanly@cdha.nshealth.ca.
14
École de Réadaptation, Université de Montréal, Montreal, QC, Canada. debbie.feldman@umontreal.ca.
15
Department of Medicine, University of Alberta, Edmonton, AB, Canada. walter.maksymowych@ualberta.ca.
16
Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. cpeschken@hsc.mb.ca.
17
Department of Medicine, University of Calgary, Calgary, AB, Canada. ccbarnab@ucalgary.ca.
18
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. ccbarnab@ucalgary.ca.
19
Department of Medicine, University of Calgary, Calgary, AB, Canada. sedworth@ucalgary.ca.
20
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. sedworth@ucalgary.ca.
21
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. sasha.bernatsky@mcgill.ca.
22
Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building (V2.09), Montreal, QC, H3A 1A1, Canada. sasha.bernatsky@mcgill.ca.

Abstract

INTRODUCTION:

Use of disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) may prevent joint damage and potentially reduce joint replacement surgeries. We assessed the association between RA drug use and joint replacement in Quebec, Canada.

METHODS:

A cohort of new-onset RA patients was identified from Quebec's physician billing and hospitalization databases from 2002-2011. The outcome was defined using procedure codes submitted by orthopedic surgeons. Medication use was obtained from pharmacy databases. We used alternative Cox regression models with time-dependent variables measuring the cumulative effects of past use during different time windows (one model focussing on the first year after cohort entry) for methotrexate (MTX), and other DMARDs. Models were adjusted for baseline sociodemographics, co-morbidity and prior health service use, time-dependent cumulative use of other drugs (anti-tumor necrosis factor [anti-TNF] agents, other biologics, cyclooxygenase-2 inhibitors [COXIBs], nonselective nonsteroidal antiinflammatory drugs [NSAIDs], and systemic steroids), and markers of disease severity.

RESULTS:

During follow-up, 608 joint replacements occurred among 11,333 patients (median follow-up: 4.6 years). The best-fitting model relied on the cumulative early use (within the first year after cohort entry) of MTX and of other DMARDs, with an interaction between MTX and other DMARDs. In this model, greater exposure within the first year, to either MTX (adjusted hazard ratio, HR = 0.95 per 1 month, 95% confidence interval, 95% CI 0.93-0.97) or other DMARDs (HR = 0.97, 95% CI 0.95-0.99) was associated with longer time to joint replacement.

CONCLUSIONS:

Our results suggest that longer exposure to either methotrexate (MTX) or other DMARDs within the first year after RA diagnosis is associated with longer time to joint replacement surgery.

PMID:
26235697
PMCID:
PMC4522999
DOI:
10.1186/s13075-015-0713-3
[Indexed for MEDLINE]
Free PMC Article
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