Biologic therapy may not reduce need for surgery in older patients with rheumatic deformities

Treatment with biologic disease-modifying anti-rheumatic drugs may not decrease the need for upper extremity reconstructive surgery in older adults with rheumatoid arthritis, according to recently presented research.

Medicare Part A, Part B and Part D were studied to identify 250,453 Medicare beneficiaries with rheumatoid arthritis (RA) through fee-for-service claims. National drug codes were used to identify patients who received conventional disease-modifying anti-rheumatic drugs (DMARDs) biologic DMARDS (bDMARDs) and patients who did not receive either. Using ICD-9 codes for procedures conducted in the elbow, hand, shoulder and wrist, the researchers identified 2.4% of the patients in the cohort who underwent reconstructive surgery between 2006 and 2012.

Hierarchcal logistic regression was used to analyze the data and showed that patients who received infusions or injections of bDMARDs were more likely to undergo upper extremity reconstruction compared to patients who received conventional or no DMARDs after adjusting for patient and regional factors. Patients who were maintained on bDMARDs and visited a rheumatologist more than three times per year were two times as likely to have upper extremity surgery compared to patients who received conventional or no DMARDs and had fewer visits to a rheumatologist.

“Given the substantial cost and immunosuppression risk associated with biologic DMARDs, comparative evidence is needed to discern which patients will derive benefit from medical or surgical intervention, and surgeons should continue to play an integral role in the multidisciplinary care of RA patients,” the researchers wrote. – by Shirley Pulawski

Reference:

Waljee JF, et al. Paper #43. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 10-12, 2015; Seattle.

Disclosure: The researchers report no relevant financial disclosures.