Surgical treatment of rheumatic diseases

Assessment Objectives

The report focuses on the scientific basis for surgical treatment of rheumatic diseases: specifically, changes resulting from chronic joint inflammation, joint inflammation resulting from psoriasis, and joint inflammation in the spine. The report also assesses needs and costs related to these conditions, based on current indications.

Assessment Strategy

Structured overview, cost analysis.

Primary Data Collection

Systematic review of the literature, including databases and a review of the reference lists.

Review Process

Internal review by the project group, the SBU Board of Directors, and the SBU Scientific Advisory Committee. External review by experts in the field.

Conclusions

The scientific literature on the benefits of surgical treatment for rheumatic diseases shows that scientific methods in the field can improve substantially. Currently, the methods are evaluated largely on the basis of accepted clinical practice and uncontrolled studies. The methods which are considered to be still under development in the field of rheumatic surgery should be applied only when accompanied by followup studies and assessments. Individuals active in this field should assume the additional responsibility for controlling the selection of prosthetic material and surgical methods.

There appears to be an unmet need for surgical treatment of rheumatic disorders. However, this judgment is based on the present indications, which rest on a weak scientific foundation. In Sweden, the expertise is available to treat more patients, but the potential is limited mainly because of insufficient resources at the surgical units.

All patients with advanced rheumatoid arthritis should be assessed by rheumatologists, and, if needed, by a surgeon specialized in rheumatic disorders to evaluate the possible need for surgery.

The cost of rheumatic surgery in Sweden is estimated at approximately 175 million SEK per year, or 40 000 SEK per operated patient. The costs should be viewed in relation to the interventions that would otherwise be needed for people who would successively deteriorate and become more dependent on others.