Joint Surgery in Tunisian Rheumatoid Arthritis Patients: Prevalence and Risk Factors
Olfa SAIDANE1, Leila GAFSI2, Aicha Ben TEKAYA1, Ines MAHMOUD1, Rawdha TEKAYA1, Leila ABDELMOULA1
1Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
2Department of Rheumatology, Polyclinic El Omrane, Tunis, Tunisia
Keywords: Joints, rheumatoid arthritis, risk factors, surgery, Tunisian
Objectives: This study aims to assess the prevalence of joint surgery in Tunisian patients with rheumatoid arthritis (RA) and to determine the risk factors of surgical treatment.
Patients and methods: This retrospective cross-sectional study was performed over a period of 15 years between January 2000 and December 2014 and included 500 Tunisian patients with RA (78 males, 422 females; mean age 53.4 years; range, 21 to 83 years). The prevalence of joint surgery indication was evaluated. Clinical, paraclinical and therapeutic characteristics of RA were compared according to the need of surgery.
Results: Female to male ratio was 5. The indication of joint surgery was noted in 59 patients (12%). Knee joint surgery was the most performed surgical procedure (56% of surgical treatment). A decrease in surgery prevalence from 30% in 2004 to 4% in 2013 was noted. Statistical study showed that factors associated with joint surgery were: delayed diagnosis (p=0.037), long RA duration (p=0.017), young onset of RA (p<0.001), presence of joint deformities (p=0.034), presence of osteoporosis (p=0.029), presence of antinuclear antibodies (p<0.001), combination therapy of methotrexate with other conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) (p=0.001), short period of first medical treatment (p=0.012) and high erythrocyte sedimentation rate (ESR) (p=0.027). In multivariate analysis, three factors were independently related to the use of joint surgery: age at disease onset [odds ratio (OR): 2.799 95% confidence interval (CI): 1.49-5.22; p=0.01], high ESR level (OR: 2.807 95% CI: 1.5-5.24; p=0.01) and association of methotrexate with other csDMARDs (OR: 3.500 95% CI: 1.61-7.56; p=0.01).
Conclusion: Twelve percent of RA patients needed joint surgical treatment. Predictive factors of surgery were age at disease onset, high ESR level and association of methotrexate with other csDMARDs.
Citation: Saidane O, Gafsi L, Tekaya AB, Mahmoud I, Tekaya R, Abdelmoula L. Joint Surgery in Tunisian Rheumatoid Arthritis Patients: Prevalence and Risk Factors. Arch Rheumatol 2020;35(3):426-434.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.