Clinical Edge

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Biologic DMARDs Decrease Rates of Upper Limb Joint Replacement

Key clinical point: The incidence of upper limb joint replacement has decreased since the introduction of biologic disease-modifying antirheumatic drugs (DMARDs).

Major finding: The 5-year incidence rate of joint replacements in rheumatoid arthritis patients decreased by approximately -0.08 per 1,000 person-years annually from 2003 through 2012, the last year analyzed, while rates among controls increased during the same time period.

Study details: The data come from 18,654 incident patients with rheumatoid arthritis in the Danish National Patient Register during 1996-2012 and 186,152 matched controls.

Disclosures: The study was supported by the Danish Rheumatism Association, the Bjarne Jensen Foundation, the Oak Foundation, the Danish Council for Independent Research, and the NIHR Biomedical Research Centre. Lead author Dr. Cordtz had no financial conflicts to disclose.


Cordtz R et al. Arthritis Care Res. 2020 Jan 9. doi: 10.1002/acr.23835


In the “biologic era,” loosely considered to be after 2000, we have defined new targets for control of RA, including early initiation and aggressive treatment, use of objective disease activity measures to reach disease remission, and reduction of radiographic progression. The current study looks at rates of upper limb joint replacement as a proxy for severe disease in that joint. Using a large Danish registry, the authors looked at joint replacements in RA patients vs age- and sex-matched controls from 1996-2001 and 2003-2016 (2002 was left out as a “lag” year as this was the year in which TNF-inhibitor use increased dramatically). The study found a constant incidence rate of surgeries in the pre-biologic period, with an annual decrease in the incidence rate (IR) among RA patients (and increase among controls) in the biologic period. The study is suggestive of biologics’ impact surgery rates, though the use of more aggressive RA treatment algorithms using conventional non-biologic DMARDs or a change in the incidence of RA (a possibility given earlier diagnosis) could also affect the study’s outcomes.—Arundathi Jayatilleke, MD