Autoimmune Connective Tissue Diseases and the Risk of Rotator Cuff Repair Surgery: A Population-Based Retrospective Cohort Study

Shih-Wei Huang; Che-Li Lin; Li-Fong Lin; Chi-Chang Huang; Tsan-Hon Liou; Hui-Wen Lin

doi:10.1136/bmjopen-2018-023848

Autoimmune Connective Tissue Diseases and the Risk of Rotator Cuff Repair Surgery: A Population-Based Retrospective Cohort Study

BMJ Open. 2019 Feb 25;9(2):e023848. doi: 10.1136/bmjopen-2018-023848.

Authors

Shih-Wei Huang^{1

2

3}, Che-Li Lin^{4

5}, Li-Fong Lin^{1

6}, Chi-Chang Huang³, Tsan-Hon Liou^{1

2}, Hui-Wen Lin^{7

8}

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
² Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
³ Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan.
⁴ Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
⁵ Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
⁶ Institute of Gerontology and Health Management, Taipei Medical University, Taipei, Taiwan.
⁷ Department of Mathematics, Soochow University, Taipei, Taiwan.
⁸ Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

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.

Keywords: orthopaedic sports trauma; rheumatology; shoulder.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Case-Control Studies
Connective Tissue Diseases / complications*
Connective Tissue Diseases / drug therapy
Databases, Factual
Female
Humans
Longitudinal Studies
Male
Middle Aged
Retrospective Studies
Risk Factors
Rotator Cuff Injuries / etiology
Rotator Cuff Injuries / surgery*
Steroids / therapeutic use
Young Adult

Substances

Steroids