The need for joint surgery is declining among rheumatoid arthritis patients, possibly because they can now more effectively manage the disease with medication, Mayo Clinic research has found.

When people diagnosed with arthritis since the mid-1990s do need orthopedic surgery, it now is more often on the knees rather than the hips, the study shows. The findings are published online in The Journal of Rheumatology.

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Rheumatoid arthritis is an autoimmune disorder in which the immune system mistakenly attacks the body's tissues, causing painful joint inflammation that can eventually result in bone erosion and joint deformity. The disease is more common in women than in men. Early on, rheumatoid arthritis tends to affect the hands and feet, and as it progresses, often spreads to the knees, ankles, hips and shoulders.

Using data from the Rochester Epidemiology Project, researchers reviewed medical records from all orthopedic surgeries following the diagnosis of rheumatoid arthritis in adults in Olmsted County, Minn. The procedures included primary total joint arthroplasty such as hip or knee replacement, joint reconstruction, soft tissue procedures, and revision arthroplasty. They found that roughly 27 percent of patients diagnosed with rheumatoid arthritis from 1980-94 needed at least one joint surgery within 10 years of diagnosis, compared with 19.5 percent for those found to have the disease from 1995-2007.

More aggressive use of antirheumatic drugs known as DMARDS is likely behind the decline, the researchers say. Improved awareness of the long-term adverse consequences of the disease and the need for early treatment may also be factors in improving the outcomes of these patients.

"The findings of this study are encouraging for patients and their families," says co-author Eric Matteson, M.D., chair of rheumatology at Mayo Clinic in Rochester. "The improvement in the disease course, with less joint damage and need for surgery in recent decades reflects the positive impact of modern therapy for rheumatoid arthritis, and highlights the importance of active disease management."

The new research found that rheumatoid arthritis patients are having joint surgery on hips and knees at rates similar to those of people with other forms of arthritis, and are having less foot and ankle surgery than in the past. Much as in the general population, obese patients were more likely to have joint surgery, and among that group, knee surgery was most commonly the procedure needed.

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