People diagnosed with rheumatoid arthritis, or RA, in the past 15 years or so are less likely to need joint surgery than are patients diagnosed previously, according to a new study published online in The Journal of Rheumatology. Researchers suggest this is due to more aggressive treatment with traditional disease-modifying antirheumatic drugs, such as methotrexate, and the introduction of biologic agents.

Intrigued by earlier research that showed a decline in RA-related surgeries, Eric Matteson, MD, chair of rheumatology at Mayo Clinic in Rochester, Minn., and his colleagues reviewed the medical records of 813 patients with RA who had orthopeadic surgery between 1980 and 2007. Procedures included total hip or knee replacement, joint reconstruction, soft tissue procedures and joint replacement revisions.

They found an overall reduction in joint surgeries. After adjusting for various factors, about 27 percent of patients diagnosed with RA between 1980 and 1994 needed at least one orthopeadic surgery in the 10 years following diagnosis, whereas only 19.5 percent of those diagnosed between 1995 and 2007 did.

For example, 6 percent of patients diagnosed with RA between 1995 and 2007 required knee surgery within the first 10 years, compared with 11 percent of those diagnosed between between 1980 and 1994.

And there was a significant decline in small-joint surgeries – those involving the ankles, feet or hands. For example, hand surgeries dropped from 6.3 percent in the 1980 to 1994 group to 2.5 percent in the 1995 to 2007 cohort.

"We found that people with rheumatoid arthritis are now having surgery on their hips and knees at rates very similar to people with osteoarthritis (OA) and having less small-joint surgery than in the past," Dr. Matteson says. "We believe that this is because of improved treatment in recent decades – a finding that highlights the importance of active disease management."

In the past, people with RA had surgery more often than people with OA due to more severe joint damage at a younger age.