Background Long term studies of the spondyloarthropathies have identified early hip joint involvement as a marker for severe disease and disability. Psoriatic spondylitis (PsSp) results in hip arthroplasty more frequently than primary ankylosing spondylitis. It is not clear whether the risk for hip involvement exists only for PsSp or other variants of PsAr.
Objectives To evaluate the prevalence of hip joint involvement cohort of PsAr patients. To determine whether gender, type of psoriasis, PsAr peripheral joint pattern, age of onset of disease, presence of spondylitis are associated with the risk of hip joint involvement. To determine the frequency of hip arthroplasty in these patients.
Methods This is a retrospective cohort study of 417 patients with PsAr treated at a single tertiary academic centre over a 15 year period. Patient characteristics and outcome were abstracted by chart review. Radiographs of patients with hip joint disease were reviewed.
Results 27 PsAr patients (6.5%) were diagnosed with hip joint involvement. 60% had biltaeral involvement. Gender, type of psoriasis, nail involvement, pattern of peripheral psoriatic arthritis, DIP joint involvement, or clinical enthesitis were not associated with hip joint disease. Sacroiliitis or spondylitis were strongly associated with hip disease (p < 0.01), as was early age of onset of PsAr (p < 0.001). 27% of the spondylitis patients developed hip disease. 37% of the patients with hip disease required total hip arthroplasty (THA).
Conclusion Hip joint involvement in psoriatic arthritis is strongly associated with early onset psoriatic arthritis and the presence of psoriatic spondylitis. A high risk of premature THA exists. Better strategies for early diagnosis and medical intervention are needed.
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