Too Little Too Late: Effect of Poor Access to Biologics for Patients with Rheumatoid Arthritis

Biologic disease-modifying antirheumatic drugs (bDMARD), in particular anti-tumor necrosis factor (anti-TNF) medications, which were developed in the 1990s, have improved the radiographic and functional status of patients with rheumatoid arthritis (RA)1. It has been thought as a corollary that rates of joint replacement in patients with RA would decrease. Results in various national databases since the advent of biologic medications have been discrepant; for example, in a US cohort there was a decrease in arthroplasty in juvenile idiopathic arthritis, but not RA from 1991 to 20052, whereas in Ireland the arthroplasty rate was halved from 1995 to 20103. In Japan there was no change in the rate up to 2008, while in Sweden the hip arthroplasty rate decreased, but the knee rate did not4. Overall, however, the trend seems to be toward lower rates of arthroplasty in patients with RA. An article in this issue of The Journal , by Stamp, et al 5, provides an interesting analysis of the rates of joint replacement in New Zealand from 1999 to 2015 in both OA and RA since the advent of … Address correspondence to Dr. B.K. Johnson, Jacobi/NCB, Rheumatology, 1400 Pelham Parkway, South Building 1, Suite 306, New York, New York 10461, USA. E-mail: beverly.johnson06{at}gmail.com