Rheumatoid arthritis (RA) patients can have substantial long-term consequences. One 18-year longitudinal study published in 1998 determined that 25% of all patients with RA required total joint replacement surgery. Severe rheumatoid arthritis study assesses the effect of early anti-tumour necrosis factor (TNF) therapy in patients with severe rheumatoid arthritis (RA) on the successive risk of total knee replacement (TKR) surgery.

This retrospective experimental study involved a hospital-based cohort of 200 patients recognised with severe RA who received therapy with anti-TNF therapy between 2003 and 2014. Sex, age, BMI, and the time from the diagnosis of RA to the initiation of anti-TNF treatment were analysed. 84 patients underwent an early intervention (≤3 years from the diagnosis of RA to the initiation of anti-TNF treatment), and 116 underwent a late intervention(>3 years from the diagnosis of RA to the commencement of anti-TNF treatment). Five (6.0%) patients in the prior intervention group underwent TKR differentiate to 31 (26.7%) in the late intervention group (p = 0.023). After modifying for confounding aspect, the late intervention group still had a consequently higher risk of TKR (p = 0.004; odds ratio, 5.572; 95% confidence interval, 1.933–16.062). Those undergo therapy involved methotrexate had lower chances of TKR (p = 0.004; odds ratio, 0.287; 95% confidence interval, 0.122–0.672).

Delayed commencement of anti-TNF therapy in the treatment of severe RA was related to an increased risk of TKR surgery. Adding methotrexate treatment reduced the risk of future TKR.