Incidence, Predictors of Orthopedic Surgery in Psoriatic Arthritis

Despite the increased use of biologic agents for the treatment of psoriatic arthritis (PsA) over the past few decades, the prognosis in patients with PsA has not changed with respect to their risk for orthopedic surgery, according to study results published in The Journal of Rheumatology.

The investigators sought to examine the incidence of orthopedic procedures in individuals with PsA in western Norway and whether patient characteristics, treatment, and time of diagnosis affect the need for surgical intervention. They reviewed the medical history of 1432 patients with possible PsA. A total of 590 individuals with sufficient journal information and a confirmed diagnosis of PsA were included in the study. Mean patient age was 49 years and 52% of the participants were women. All relevant orthopedic procedures were obtained from the administrative patient hospital records. Survival analyses assessed the effect of various factors, including year of PsA diagnosis, gender, age, radiographic changes, treatment, and disease activity on a patient’s risk for surgery.

Overall, a total of 171 procedures (53% prostheses, 25% synovectomies, and 15% arthrodesis) were performed in 117 patients. Factors that significantly increased a participant’s risk for surgery included: age ≥70 years at PsA diagnosis (relative risk [RR], 2.4; 95% CI, 1.5-4.1; P =.001), female sex (RR, 1.9; 95% CI, 1.3-2.8; P =.001), arthritis on initial radiographs (RR, 2.2; 95% CI, 1.3-4.0; P =.006), and maximum erythrocyte sedimentation rate 30 to 59 mm/h (RR, 1.6; 95% CI, 1.1-2.5; P =.026). Time period at PsA diagnosis had no effect on a patient’s outcome.

Based on a sub-analysis of surgical procedures exclusive of hip and knee arthroplasty, PsA diagnosis in earlier years (1954 to 1985 vs 1999 to 2011) was a significant risk factor for surgery (RR, 2.1; P =.042). The type of antirheumatic therapy used by patients was shown to change significantly over time.

The investigators concluded that 20% of participants with PsA underwent orthopedic surgery, despite the change in treatment over the years. Although the maximum disease activity appears to have decreased over time in patients with PsA, the risk for surgery was not affected by the year of PsA diagnosis. Researchers suggested that these findings may be attributable to the rise in large joint replacements in the general population.

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Reference

Nystad TW, Husum YS, Furnes ON, Fevang BS. Incidence and predictive factors for orthopedic surgery in patients with psoriatic arthritis [published online September 1, 2018]. J Rheumatol. doi:10.3899/jrheum.180203