Trend in the use of methotrexate (MTX) and biological disease-modifying anti-rheumatic drugs (DMARDs) has led to decrease the number of musculoskeletal surgery in patients with rheumatoid arthritis (RA). We investigated the changes in incidence of surgery and prescription of postoperative rehabilitation.

Retrospective study was performed using medical records in Shimane University Hospital from 2002 to 2016. The number of surgery, prescription of postoperative rehabilitation, duration of hospital stay, and status of pharmacological treatment were studied in 152 patients. Linear regression analysis and Bonferroni/Dunn test were used for statistical analysis for the time trends in the incidence of surgeries.

There was a decreasing trend in the incidence of surgery, especially in the surgery of lower extremities (P=0.08). On the other hand, there was an increasing trend in the incidence of spinal surgery and operations in upper extremities. Hospitalization days became shorter (P<0.01) and the incidence of postoperative rehabilitation decreased, especially for occupational therapy (OT). The proportion of patients receiving MTX and DMARDs significantly increased from 33.3% and 0% in 2002 to 63.2% and 52.6% in 2016, respectively.

The incidence of surgery of lower extremities decreased, however, the number of surgery in upper extremities increased among the patients with improved ADL and QOL owing to the use of effective drugs. Decreasing prescription of OT might bring a negative influence to individualized joint protection education in patients with RA.