Intensifying treatment of rheumatoid arthritis with combinations of traditional disease-modifying anti-rheumatic drugs among patients with persistent disease did not reduce the need for large joint surgery

Objective: To analyse how treatment of patients with rheumatoid arthritis (RA) influenced the duration of the disease before the first large joint surgery, arthrodesis or arthroplasty, in two patient cohorts 10 years apart. Methods: Data on patients with RA having an arthrodesis or arthroplasty of a large joint from 1990 to 1992 and from 2000 to 2002 and the type of medication used among all patients with RA in 1988-2002 were extracted from the data set of Kuopio University Hospital. Results: The median duration of the disease before the decision of arthrodesis was 6.0 (range 1-25) years in 1990-92 and 9.0 (1-31) years (p = 0.307) in 2000-02, and of arthroplasty 10.5 (0-27) and 12.5 (0-59) years (p = 0.820), respectively. A significant shift from only symptomatic treatment or one disease-modifying antirheumatic drug (DMARD) to the more common use of immunosuppressants and/or combinations of at least two DMARDs occurred between 1992 and 2002. Conclusions: Treatment of RA at diagnosis and during the first years after diagnosis was traditional. Intensifying treatment later in the disease course did not reduce the need for large joint surgery as it occurred in the same time range in both cohorts.