When rheumatologist Erdal Diri started working at Trinity Health Center in Minot, N.D., a decade ago, he saw many rheumatoid arthritis patients referred to him by surgeons frustrated by the levels of joint inflammation they saw.

“Most of these patients were ending up with orthopaedic surgeons and during surgery, they opened up their joints and they were so inflamed that they closed them up and sent the patients to us” to get the inflammation under control before joints could be operated on, recalls Dr. Diri. Better inflammation-fighting drugs and a new approach to treating RA more aggressively has changed that, he says.  From an average of 30 to 40 RA patients being sent for surgery a year at this rural hospital, Dr. Diri now sends only 4 to 5.

“We get control of inflammation at an earlier stage, and we don’t see the joint deformity that we used to see, so the numbers of surgeries are going down. We are living in the anti-TNF era, and we’re seeing the results of that now,” he says.

Biologic drugs that suppress inflammatory agents like tumor necrosis factor (TNF) and others are indeed making a positive impact for people with RA. Surgery to repair joints deformed by RA is down sharply nationwide over the last 20 years, according to recent research.

The most recent study, conducted by rheumatologists at the Mayo Clinic in Rochester, Minn., and published in Journal of Rheumatology in January 2012, tracked surgeries among 813 RA patients from 1980 to 2007. The researchers, led by Eric L. Matteson, MD, found that the incidence of any joint surgery within 10 years of their diagnosis went from 27.3 percent in the 1980 to 1994 period to 19.5 percent from 1995 to 2007. Soft-tissue surgeries declined the most over the period studied, but total joint replacements were down as well. Women and obese RA patients still had more surgeries than men or thinner patients.

In an earlier study published in the journal Annals of the Rheumatic Diseases, researchers supported by the Intramural Research Program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS, part of the National Institutes of Health) also tracked a group of California RA patients from 1983 to 2007 and found similar declines. Knee replacements for these patients dropped 19 percent over the period and hip replacements dropped by 40 percent.  
 

Not Just a Perception

Having long-term studies that track groups of RA patients over many years makes this decline more than anecdotal, says Joan Bathon, MD, director of the division of rheumatology at Columbia University Medical Center/New York‐Presbyterian Hospital in New York.