You are here

  • Home
  • Archive
  • Volume 9, Issue 2
  • Autoimmune Connective Tissue Diseases and the Risk of Rotator Cuff Repair Surgery: A Population-Based Retrospective Cohort Study

Article Text

Article menu

Download PDFPDF

XML
Rheumatology
Research
Autoimmune Connective Tissue Diseases and the Risk of Rotator Cuff Repair Surgery: A Population-Based Retrospective Cohort Study
  1. Shih-Wei Huang1,2,3,
  2. Che-Li Lin4,5,
  3. Li-Fong Lin1,6,
  4. Chi-Chang Huang3,
  5. Tsan-Hon Liou1,2,
  6. Hui-Wen Lin7,8
  1. 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
  2. 2 Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  3. 3 Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
  4. 4 Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
  5. 5 Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
  6. 6 Institute of Gerontology and Health Management, Taipei Medical University, Taipei, Taiwan
  7. 7 Department of Mathematics, Soochow University, Taipei, Taiwan
  8. 8 Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Dr Hui-Wen Lin; linhw{at}tmu.edu.tw

Abstract

Objectives Autoimmune connective tissue diseases (ACTDs) commonly involve the shoulder joint; however, clinical epidemiological studies investigating their association with tendons are scant. Rotator cuff (RC) tears can cause shoulder disability, and surgical intervention is usually required. The study investigated RC repair surgery risk in ACTD patients. The effect of anti-inflammatory medication on RC repair surgery risk was also investigated.

Methods We conducted a retrospective cohort study with a 7-year longitudinal follow-up period. Patients with systemic lupus erythematosus, systemic sclerosis, sicca syndrome, dermatomyositis and polymyositis diagnoses between 2004 and 2008 were enrolled. The control cohort comprised age- and sex-matched controls. The HR and adjusted HR (aHR) were estimated for the risk of RC surgery between ACTD and control cohorts after adjustment for confounders. Furthermore, the effects of steroid and non-steroidal anti-inflammatory drug (NSAID) use on the HR and aHR of RC surgery risk were analysed.

Results We enrolled 5019 ACTD patients and 25 095 controls in the ACTD and control cohorts, respectively. RC surgery incidence was 49 and 24 per 100 000 person-years in the ACTD and control cohorts, respectively. In the ACTD cohort, the crude HR for RC surgery was 2.08 (95% CI , 1.08 to 4.02, p<0.05), and the aHR was 1.97 (95% CI, 1.01 to 3.82, p<0.05). The ACTD patients who used NSAIDs had an aHR of 3.13 (95% CI, 1.21 to 8.07, p<0.05) compared with the controls, but the ACTD patients who used steroids did not have a significantly higher aHR than the controls.

Conclusions ACTD patients had an increased risk of RC repair surgery. However, no difference was found in RC surgery risk when steroids were used compared with the control cohort. This could indicate that inflammation control may be a strategy for managing subsequent RC lesions.

  • rheumatology
  • orthopaedic sports trauma
  • shoulder

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-023848

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors SWH participated in the study design, conducted the data analysis, drafted the initial manuscript and approved the final manuscript as submitted. CLL conducted the data analysis, drafted the manuscript and approved the final manuscript as submitted. LFL contributed to the study design, reviewed and revised the manuscript, and approved the final manuscript as submitted. CCH reviewed and revised the manuscript and approved the final manuscript as submitted. T-HL participated in the study design, reviewed and revised the manuscript and approved the final manuscript as submitted. RE designed and conceptualised the study and approved the final manuscript as submitted. H-WL participated in the study design, conducted the data analysis, revised the manuscript and approved the final manuscript as submitted.

    • Funding This study was supported by the Taipei Medical University and Shuang Ho Hospital (107TMU-SHH-08). The funding sources played no role in the design, implementation, data analysis, interpretation, or reporting of the study.

    • Competing interests None declared.

    • Ethics approval Institutional Review Board of the University of Taipei (UT-IRB No: IRB-2018-07).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.

    • Patient consent for publication Not required.