Rheumatoid arthritis increases complication risks in elderly hip fracture patients.: A Japanese nationwide medical claims database study.

ABSTRACT

OBJECTIVES: Rheumatoid arthritis (RA) is a common autoimmune disorder characterized by chronic inflammation and periarticular bone loss, leading to systemic osteoporosis and heightened fracture susceptibility, especially hip fractures among the elderly. This study aimed to evaluate the outcomes and complications associated with hip fractures in patients with RA relative to those without RA. METHODS: Using the Japanese National Administrative Diagnosis Procedure Combination (DPC) database, we examined cases of femoral neck fractures from April 2016 to March 2023. After one to three propensity score matching for age, sex, and complications, we examined the association between RA, complications, and mortality during hospitalization in elderly patients with hip fractures. RESULTS: The findings revealed that elderly Japanese RA patients with hip fractures had significantly higher complications of pneumonia than elderly hip fracture patients without RA, with a ratio of 1.232 (95% CI 1.065-1.426, p=0.0056), and pulmonary embolism, with a ratio of 1.155 (95% CI 1.036-1.287, p=0.009) in multivariate logistic regression analyses. Although not significantly elevated, it also found a trend toward higher mortality during hospitalization, with a ratio of 1.179 (95% CI 0.973-1.429, p=0.096). CONCLUSIONS: A substantial study based on the Japanese DPC database revealed a significant association between RA and increased complications, including pneumonia and pulmonary embolism. On the other hand, there was a nonsignificant but higher trend for risk of mortality during hospitalization for hip fracture in elderly RA patients. Implementing preventive strategies is essential to minimizing complications in the treatment of hip fractures in patients with RA.