Background/Purpose: Rising rates of total knee arthroplasty (TKA) in younger adults with knee osteoarthritis (OA) has prompted concern about surgical appropriateness. We compared patient appropriateness for TKA, using previously validated criteria, and surgeons’ recommendations for TKA, by patient age.
Methods: This cross-sectional study recruited patients with knee OA referred for TKA consultation to two centralized provincial arthroplasty intake centers in Alberta, Canada. Patients aged 30 years or older and determined by the surgeon to have primary knee OA on physical examination and imaging were eligible. Individuals with inflammatory arthritis were excluded. To examine age effects, recruitment continued until there was at least 200 individuals aged 30-59, 60-69 and ≥ 70 years. A pre-consult questionnaire assessed measures of patients’ TKA appropriateness (need: knee symptoms, prior OA treatment; readiness/willingness to undergo TKA; health status; expectations) and contextual factors. Post-consultation, surgeons reported if TKA had been recommended and if not, why. Using multivariable logistic regression, we assessed the relationships between patient age (< 60 versus ≥ 60) and TKA appropriateness and receipt of surgeon recommendation for TKA.
Results: Of 2,064 participants, 26.0% were < 60 years of age, 68.0% female, 35.6% employed. Compared to older participants, younger participants reported significantly worse knee symptoms, higher use of OA therapies and similar TKA readiness/willingness. They were also more likely to have BMI >40 kg/m2, smoke and endorse return to exercise/sports as a very important TKA outcome. TKA was offered to 1,525 individuals (73.9%). In multivariable analyses, controlling for TKA appropriateness, we found no relationship between patient age and surgeons’ recommendations for TKA (OR, odds ratio, 0.81; 95% CI, confidence interval, 0.59 to 1.10). Surgeons were significantly more likely to recommend TKA to those with TKA need, willingness and for whom improved ability to perform daily activities was very important. They were less likely to recommend surgery to smokers and for whom return to exercise/sport was important.
Conclusion: Among individuals referred for surgical consultation regarding TKA for knee OA, we found that younger patients (< 60 years old) had comparable TKA need, readiness and willingness as those aged 60 years or older. However, younger individuals were more likely to be obese, smoke, and desire to return to sport after TKA, which may increase risk for complications, including early revision. Incorporation of TKA appropriateness criteria into patient referral and patient-surgeon decision-making regarding TKA has potential to facilitate a balanced consideration of TKA benefits alongside the risks in a growing population of young, obese individuals with knee OA.
Using a bilingual online survey, we ascertained Canadians’ views about using administrative databases and other publicly-collected data for health research. Respondents were generally supportive (by the end of the survey, 93% felt positively about this work), but wanted to learn more about the data access and security measures, including the role of data stewards. Our findings suggest that more education may increase public trust and support for this important research.
Document Link: https://acrabstracts.org/abstract/canadians-views-about-using-big-data-in-health-research-from-a-national-online-survey-a-partnership-of-patient-consumers-and-researchers/
Administrative databases: can they be used for pediatric rheumatic disease surveillance? a survey of Canadian pediatric rheumatologists
Poster
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.
Authors:Cristiano S. Moura, Michal Abrahamowicz, Marie-Eve Beauchamp, Diane Lacaille, Yishu Wang, Gilles Boire, Paul R. Fortin, Louis Bessette, Claire Bombardier, Jessica Widdifield, John G. Hanly, Debbie Feldman, Walter Maksymowych, Christine Peschken, Cheryl Barnabe, Steve Edworthy, Sasha Bernatsky and CAN-AIM
Health Trends Alberta October 28, 2014
Lupus in Alberta
Age-sex Specific Prevalence, By First Nations Status, 2012
In today’s issue of Health Trends Alberta, we compare age and sex-specific prevalence rates of lupus in 2012 among First Nations and Non-First Nations Albertans.
Health Trends Alberta shows self-reported prevalence of arthritis by zone and sex for 2012.
Rheumatology Billing Practices in Canada: A Survey
Poster Presentation
