NSAIDs, DMARDs, TNFis do not lower total hip/knee arthroplasty risk in AS/PsA patients

Any combination of nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), or tumuor necrosis factor inhibitors (TNFi) does not lead to a reduction in the likelihood of total hip or total knee arthroplasty (THA/TKA) among persons with ankylosing spondylitis (AS) or psoriatic arthritis (PsA), a US study has shown.

This nested case-control study was conducted using 1994–2018 data from the OptumLabs Data Warehouse, which included deidentified medical and pharmacy claims, laboratory results, and enrolment records for commercial and Medicare Advantage enrollees.

THA/TKA cases among patients with AS or PsA were matched up to four control participants by age, sex, AS/PsA diagnosis, diagnosis year, insurance type, obesity, and prior THA/TKA.

The investigators assessed AS/PsA treatment 6 months prior to THA/TKA, including DMARDs, TNFi, alone or in combination, stratified by NSAID use. They also examined the association of treatment to risk of THA/TKA using conditional logistical regression adjusting for confounders.

Of the 16,748 adults with AS, 444 underwent THA/TKA and 1,613 were matched controls. Among 34,512 adults with PsA, 1,003 were THA/TKA cases and 3,793 controls. The adjusted odds ratios for treatment category and THA/TKA had a range of 0.60 to 1.92, but none of these achieved statistical significance. Several sensitivity analyses revealed similarly null results.

“Given current utilization patterns in this population of US adults with AS and PsA, these medical therapies did not appear to be associated with less end-stage peripheral joint damage,” the investigators said.