Objectives To investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients with RA treated with biological disease-modifying antirheumatic drugs (bDMARD) within 90 days preceding surgery compared with non-treated. Methods Register-based cohort study using the Danish National Patient Register, the DANBIO rheumatology register (RA-specific confounders and treatment episodes) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs. Results In total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0.57–0.89)), but increased risk of PJI (SHR=1.46 (1.13–1.88)) and death (HR=1.25 (1.01–1.55)). In DANBIO, 345 of 1946 patients with RA with THA/TKA had received bDMARD treatment within 90 days preceding surgery. bDMARD-treated patients did not have a statistically significant increased risk of revision (SHR=1.49 (0.65–3.40)), PJI (SHR=1.61 (0.70–3.69)) nor death (HR=0.75 (0.24–2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12–7.34)) and increasing DAS28 (HR=1.49 (1.01–2.20)) were risk factors for mortality. Conclusion Patients with RA had a decreased 10-year risk of revision while the risk of death and PJI was increased compared with patients with OA following THA/TKA. bDMARD exposure was not associated with statistically significant increased risk of neither PJI nor death in this study. Glucocorticoid exposure and increased disease activity were associated with an increased risk of death.

中文翻译：

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类风湿性关节炎患者全髋或全膝关节置换术后翻修、假体关节感染和死亡率的预测因素：一项使用丹麦医疗登记册的全国性队列研究

目的 研究（1）类风湿性关节炎（RA）患者的全髋/全膝关节置换术（THA/TKA）后 10 年翻修风险和 1 年假体关节感染（PJI）风险和死亡风险的预测因素。骨关节炎（OA）患者；(2) RA 患者在手术前 90 天内接受过生物疾病缓解抗风湿药物 (bDMARD) 治疗与未接受治疗相比。方法 基于注册的队列研究使用丹麦国家患者注册、DANBIO 风湿病注册（RA 特异性混杂因素和治疗事件）和丹麦髋关节和膝关节置换术注册。生存分析用于计算混杂因素调整的子 HR (SHR) 和 HR。结果 总共有 3913 名 RA 合并 THA/TKA 患者与 120 499 名 OA 患者进行了比较。RA 患者的翻修风险降低 (SHR 0.71 (0.57–0.89))，但 PJI 风险增加 (SHR=1.46 (1.13–1.88)) 和死亡风险 (HR=1.25 (1.01–1.55))。在 DANBIO 中，1946 名患有 THA/TKA 的 RA 患者中有 345 名在手术前 90 天内接受了 bDMARD 治疗。与 bDMARD 治疗的患者相比，接受 bDMARD 治疗的患者的翻修风险（SHR=1.49（0.65-3.40））、PJI（SHR=1.61（0.70-3.69））和死亡（HR=0.75（0.24-2.33））均无统计学意义的增加。未处理。糖皮质激素暴露 (HR=2.87 (1.12–7.34)) 和增加的 DAS28 (HR=1.49 (1.01–2.20)) 是死亡率的危险因素。结论与THA/TKA后的OA患者相比，RA患者10年翻修风险降低，而死亡和PJI风险增加。在本研究中，bDMARD 暴露与 PJI 和死亡风险的统计学显着增加无关。糖皮质激素暴露和疾病活动增加与死亡风险增加有关。