Objectives To estimate surgical interventions taken place in patients of early Spondyloarthritis (SpA) and to assess whether there are differences according to SpA subgroups, gender and race. The type of intervention and the timing of interventions related to disease onset were also to be determined.
Methods Patients with SpA were asked to fill in a validated questionnaire if they had any musculoskeletal surgery, the type of surgery and the time during the disese process they had it.
From a total 425 patients with SpA 50 patients (11.7%) reported having musculoskeletal surgery at any point during the disease process. The diagnoses of the total surgery cohort (n=50) were: USpA 21 (42%), PsA=20 (40%), AS: 6 (12%); enteropathic n=3. They were 30 Caucasian, 14 Asian, 5 Africans, 1 mixed race. The delay in diagnosis of the surgical group was 5.3 years (y) ± 6.9; mean disease duration (dd) 12y ± 3.11; ESR 14.5±15; CRP 10.1±16. BASDAI score 6.7±1.9, and BASFI score 6.1±2.5.
A total of 62 musculoskeletal surgical procedures were reported from the 50 patients of total SpAs: 36 knees (including arthroscopy) 7 hips, 6 spinal, 6 hands – wrists (including carpal tunnel), 3 ankles, 2 feet, 1 elbow, 1 shoulder.
A total of 96 patients had early SpA [(PsA=47.9%, USpA 28.2%, AS 12.5%, enteropathic 9.4% ReA 1%, Juvenile 1%) (mean dd was of 1.8 y ± 0.7 mean age of disease onset 42.6y ±14.4)] 73.6% were on some form of medication. [98.9% were on NSAIDs, 62.9% on pain killers, 13.6% on steroids, 8.6% on Soulphasalazine, 6.1% on methotrexate and 1.3% on Leflunomide. Musculoskeletal surgery reported by 9 of 94 patients (9.3%) (M:F=5:4). The effectiveness of the medication of the whole early group (on a 100 mm VAS) reported as (mean ± sd) 4.2 + 2.8, while the well being over the past week was 5.9±2.7 and over the past 6 months was 6.4±2.6.
All patients but 1 had PsA. Seven out of 9 were Caucasian, 1 African and 1 mixed race. The procedures were knee arthroscopy in 4 of 9 patients; carpal tunnel decompression in 2 of 9; 1 in finger, 1 in foot and 1 total hip replacement. In 6 of 9 patients the procedures have taken place 2 years prior to systemic disease onset and referral to hospital while in 2 of 9 one year prior to hospital attendance and 1 of 9 patients 3 years prior to hospital referral.
Conclusions The surgery cohort has more serious disease manifested by BASDAI and BASFI. Caucasian male patients with early PsA have surgery earlier in the disease process.
Knee surgery is the commoner surgical procedure in the total group and 1 in 10 patients with early disease has some form of surgery prior to deciding hospital referral.
Disclosure of Interest None Declared