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Physiotherapists are seeing a decline in the number of rheumatoid arthritis patients requiring joint replacement surgery - but the reason for this cannot necessarily be easily narrowed down to a single cause.
This is according to a new study from the University of Oxford, which has analysed data from more than 11,000 patients in an attempt to better understand the key drivers of improvements in rheumatoid arthritis management over the last 25 years.
One of the main reasons for the dwindling reliance on joint replacement surgery is that modern treatment methods have moved from basic symptom relief to direct treatment of the disease itself, a change that has often been attributed to the introduction of biologic TNF inhibitor therapies in the late 1990s.
This study identified a significant 40 per cent reduction in total hip replacements among those aged over 60 taking anti-TNFs, while hip replacement rates were cut by one-quarter in patients with more severe disease cases who took anti-TNFs. However, there was little evidence of a general association between anti-TNF use and the rate of joint replacement procedures.
The fact that these trends were not universally observable suggests that other factors may also be responsible for reducing the reliance on joint replacement surgery, including earlier diagnoses and increased prescription rates of conventional synthetic disease-modifying antirheumatic drugs.
Lead researcher Samuel Hawley said: "The use of biologic therapies has been routinely offered as an explanatory factor for the reduction in rates of joint replacement over recent years.
"Our study offers some support for this in that a reduction in hip replacement procedures was observed in older patients on anti-TNFs, although our results also suggest additional factors are likely to be involved."
Written by Mathew Horton
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