Early medication use in new-onset XXXX may delay joint replacement: results of a large population-based study.

@entity1 @entity39 @entity6822 @entity5 @entity16 @entity230 @entity1499 @entity3840 @entity309
INTRODUCTION: Use of disease-modifying anti-rheumatic drugs (DMARDs) in @entity309 ( @entity309 ) may prevent @entity16 and potentially reduce joint replacement surgeries. We assessed the association between @entity309 drug use and joint replacement in Quebec, Canada. METHODS: A cohort of new-onset @entity309 @entity1 was identified from Quebec's physician billing and hospitalization databases from 2002-2011. The outcome was defined using procedure codes submitted by orthopedic surgeons. Medication use was obtained from pharmacy databases. We used alternative Cox regression models with time-dependent variables measuring the cumulative effects of past use during different time windows (one model focussing on the first year after cohort entry) for @entity1499 ( @entity6822 ), and other DMARDs. Models were adjusted for baseline sociodemographics, co-morbidity and prior health service use, time-dependent cumulative use of other drugs (anti- @entity5 @entity39 factor [anti-TNF] agents, other biologics, @entity3840 inhibitors [COXIBs], nonselective nonsteroidal antiinflammatory drugs [NSAIDs], and systemic @entity230 ), and markers of disease severity. RESULTS: During follow-up, 608 joint replacements occurred among 11,333 @entity1 (median follow-up: 4.6  years). The best-fitting model relied on the cumulative early use (within the first year after cohort entry) of @entity6822 and of other DMARDs, with an interaction between @entity6822 and other DMARDs. In this model, greater exposure within the first year, to either @entity6822 (adjusted hazard ratio, HR   =   0.95 per 1  month, 95  % confidence interval, 95  % CI 0.93-0.97) or other DMARDs (HR   =   0.97, 95 % CI 0.95-0.99) was associated with longer time to joint replacement. CONCLUSIONS: Our results suggest that longer exposure to either @entity1499 ( @entity6822 ) or other DMARDs within the first year after @entity309 diagnosis is associated with longer time to joint replacement surgery.
