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Periarticular osteophyte formation protects against total knee arthroplasty in rheumatoid arthritis patients with advanced joint damage

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Abstract

Objective

Periarticular osteophyte formation is observed during the repair of damaged joints in rheumatoid arthritis (RA); however, little is known about its clinical and functional roles. This study aimed to determine the influence of periarticular osteophyte formation on the incidence of total knee arthroplasty (TKA) (a surrogate for long-term outcomes of joint destruction) in patients with RA.

Methods

This retrospective longitudinal study included a total of 130 symptomatic (tender and/or swollen) knee joints in 80 patients starting biologics. Cumulative incidences of TKA were compared according to the presence or absence of osteophyte on plain anteroposterior radiograph (osteophyte (±)) and the extent of advanced joint damage as defined by Larsen’s grading system (0–II vs. III–V).

Results

Kaplan-Meier estimates showed a significantly lower cumulative incidence of TKA for the osteophyte (+) group (n = 33) compared with the osteophyte (−) group (n = 31) in the Larsen grades III–V group (38 vs. 74% at 10 years, P = 0.010), whereas no significant difference was observed between the osteophyte (+) (n = 11) and osteophyte (−) (n = 55) groups in the Larsen grades 0–II group (9 vs. 10% at 10 years). Multivariate Cox proportional hazards analysis revealed that older age (hazard ratio (HR), 1.04 per 1 year; 95% confidence interval (CI), 1.01–1.08) and osteophyte formation (HR, 0.39; 95% CI, 0.19–0.79) independently predicted TKA in the Larsen grades III–V group, whereas none of the assessed variables predicted TKA in the Larsen grades 0–II group.

Conclusion

Osteophyte formation reduces the incidence of TKA in patients with RA who have advanced joint damage.

Key Points

• Older age and Larsen grade were independent predictors of total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients.

• Periarticular osteophyte formation reduced the incidence of TKA in RA patients with Larsen grades III–V.

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Availability of data and materials

The datasets generated during and/or analyzed in the current study are available from the corresponding author on reasonable request.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Shuji Asai, Nobunori Takahashi, Kenya Terabe, Yasumori Sobue, Tsuyoshi Nishiume, Mochihito Suzuki, Yutaka Yokota, Naoki Ishiguro & Toshihisa Kojima

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  1. Shuji Asai
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  2. Nobunori Takahashi
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  3. Kenya Terabe
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  4. Yasumori Sobue
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  5. Tsuyoshi Nishiume
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  6. Mochihito Suzuki
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Contributions

SA designed the study, conducted statistical analyses, and drafted the manuscript. All authors contributed to interpretation of data, manuscript preparation, and manuscript review; approved the draft for publication; and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Shuji Asai.

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Conflict of interest

SA has received speakers’ fees from AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Takeda, and UCB Japan. NT has received speakers’ fees from AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Janssen, Mitsubishi Tanabe, Ono, Pfizer, Takeda, and UCB Japan. YS has received speakers’ fees from Astellas, Bristol-Myers Squibb, and Ono. MS has received speakers’ fees from Bristol-Myers Squibb. NI has received grant/research support, consulting fees, and/or speakers’ fees from AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Kaken, Mitsubishi Tanabe, Ono, Otsuka, Pfizer, Taisho Toyama, Takeda, and Zimmer Biomet. TK has received grant/research support and/or speakers’ fees from AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Novartis, Pfizer, and Takeda. The other authors declare no conflicts of interest.

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This study was approved by the Ethics Committee of Nagoya University Graduate School of Medicine (2019-0230) and complied with the principles set forth in the Declaration of Helsinki.

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Asai, S., Takahashi, N., Terabe, K. et al. Periarticular osteophyte formation protects against total knee arthroplasty in rheumatoid arthritis patients with advanced joint damage. Clin Rheumatol 39, 3331–3339 (2020). https://doi.org/10.1007/s10067-020-05140-1

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