Rheum Round-up: Soda and Fracture Risk, Effects of Race on TKR Outcomes, and More

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, read about the correlation between soda and fractures, whether race affects knee replacement outcomes, the current state of arthritis treatment, and cardiovascular risks following rotator cuff repair.

Postmenopausal women with a diet high in soda were more likely to sustain osteoporotic hip fracture in a recent study. Data were collected from the Women’s Health Initiative Observational Study on 72,342 postmenopausal women with more than 11.9 years of median follow-up. The data showed that while low soda intake did not put women at higher fracture risk, those who drink soda in larger quantities may be upping their chances. “Adjusted hazard ratios for incident hip fracture for the highest consumption category compared with no consumption were 1.26 (95% confidence interval [CI] 1.01-1.56) for total soda and 1.32 (95% CI 1.00-1.75) for caffeine-free soda,” the researchers observed. Caffeinated soda and incident hip fracture were not correlated (hazard ratio = 1.16; 95% CI 0.86-1.57), and in fully adjusted models, no linear trend was observed in hip fracture risk across different soda consumption levels, which researchers said pointed to a threshold effect. “A sensitivity analysis using adjudicated hip fractures showed significant associations for all three soda exposures in the highest intake groups,” the authors added.

Contrary to previous research, a study found that black race is not a statistically significant risk factor in failure and revision in total knee replacement (TKR); further, no association was observed between poverty and risk for failure or revision. To conduct their research, the study authors compared black and white patients from a prospective, single-institution TKR registry who underwent primary unilateral TKR. TKR failure was defined as either TKR revision in New York state two years or less after surgery or Hospital for Special Surgery (HSS) TKR quality of life score “not improved” or “worsened” after two years. During a median 5.3 years of follow-up, 3% of patients (n = 122) underwent revision at a mean 454 days postoperatively. Black patients had higher risk for TKR revision (hazard ratio 1.69, 95% CI 1.01–2.81); however, this was no longer significant in multivariable analysis, which found that the only predictors of revision were younger age, male sex, and constrained prosthesis. Of 2,832 cases with two-year surveys, 7% (n = 200) presented TKR failure; risk factors included were non‐osteoarthritis TKR indication, low surgeon volume, and low HSS Expectations Survey score—black race was not a factor, the researchers noted. There were no associations between community poverty and TKR revision or failure.

A study identified a significant need for a treat-to-target approach in patients with rheumatoid arthritis (RA). This study therefore sought to evaluate the burden of disease among RA patients treated with conventional synthetic disease-modifying anti-rheumatic drug (csDMARDs) for six months who do not move on to treatment with a biologic or Janus kinase inhibitors (JAKi). During the six-month study period, 29% of patients (n = 118) advanced their treatment. Treatment advances included csDMARD dose escalation (n = 55, 13%), initiation of another csDMARD (n = 33, 8%), and initiation of a biologic DMARD (n = 40, 10%). Compared to those who did not advance treatment (n = 291), patients who did were more likely to have younger age, shorter disease duration, higher disease activity, prednisone doses ≥  10 mg, lower EuroQol 5 Dimensions scores, higher Clinical Disease Activity Index (CDAI) higher disease activity measures, and higher reported pain and fatigue levels. Among patients who did not advance treatment but whose CDAI RA score remained > 10 after six months, the mean age [SD] was 66.6 [12.4] years, csDMARD use duration was 371.8 [202.3] days, and disease duration was 11.4 [11.0] years.

A new study identified predictors of patients most likely to experience venous thromboembolic events (VTEs) following rotator cuff repair (RCR) surgery. A total of 39,825 RCRs were performed during the study period; 117 (0.3%) VTEs were recorded. VTE presented at a mean 11.5 days. Most (n = 31,615) RCRs were performed arthroscopically; VTE rate did not largely differ between arthroscopic (0.3%, n = 93) versus open RCR (0.3%, n = 23). Patients with an American Society of Anesthesiologists (ASA) classification of III or IV had a greater VTE risk (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.14-2.45); other risk factors included surgery >80 minutes (OR 2.10, 95% CI 1.42-3.15), performed under general anesthesia (OR 4.38, 95% CI 1.18-36.6), and in the outpatient setting (OR 6.09, 95% CI 1.06-243.7); male sex (OR 1.53, 95% CI 1.01-2.33), bleeding disorders (OR 2.87, 95% CI 1.17-7.05), or dyspnea (OR 1.51, 95% CI 1.02-2.23). Unplanned reoperation was the most significant risk factor (OR 16.6, 95% CI 5.13-53.5).