Risk for Total Hip and Knee Arthroplasty Not Reduced by NSAIDs, DMARDs, and/or TNF Inhibitors in Patients With PsA and AS

Researchers evaluated the risk for total hip and knee arthroplasty with regard to the use of NSAIDs, DMARDs, and TNF inhibitors in patients with psoriatic arthritis and ankylosing spondylitis.

Administration of any combination of disease-modifying antirheumatic drugs (DMARDs), tumor necrosis factor inhibitors (TNFi), and nonsteroidal anti-inflammatory drugs (NSAIDs) does not reduce the risk for total hip and total knee arthroplasty (THA/TKA) in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA), according to study results published in The Journal of Rheumatology.

There is limited evidence that NSAIDs, DMARDs, and TNFi reduce total knee or hip arthroplasty in adults with PsA and AS, possibly due to a decrease in joint inflammation or the preservation of bone density.

In current study, researchers assessed whether NSAIDs, DMARDs, and/or TNFi therapy decreased the odds of THA/TKA in patients with AS and PsA.

The case-control study included data from the OptumLabs Data Warehouse. Adults with AS and PsA who underwent THA/TKA were matched with up to 4 control participants by sex, age, AS/PsA, diagnosis year of AS/PsA, insurance type, obesity, and any previous THA/TKA. Researchers evaluated the risk for THA/TKA with regard to treatment 6 months prior with DMARDs and/or TNFi, stratified by NSAID use.

A total of 444 adults with AS who had THA/TKA and 1613 matched control participants were included in the study. A total of 1003 adults with PsA who had THA/TKA and 3793 matched control participants were also included. Adjusted odds ratios for treatment category and THA/TKA ranged from 0.60 to 1.92, but they were not statistically significant. Sensitivity analyses revealed no significant association between THA/TKA and medication therapy.

Limitations of the study included its observational design, the potential for residual confounding, the limited follow-up for some study participants, the possibility of misclassification, and the fact that THA/TKA may have been due to osteoarthritis.

Researchers concluded, “In this large sample of US adults with AS and PsA, no combi­nation of NSAIDs, DMARDs, or TNFi therapy was associated with fewer THAs or TKAs. Further study should investigate strategies to mitigate end-stage peripheral arthritis in AS and PsA.”


Stovall R, Peloquin C, Felson D, Neogi T, Dubreuil M. Relation of NSAIDs, DMARDs, and TNF inhibitors for ankylosing spondylitis and psoriatic arthritis to risk of total hip and knee arthroplasty. J Rheumatol. Published online May 15, 2021. doi:10.3899/jrheum.200453

This article originally appeared on Rheumatology Advisor