Background Psoriatic arthritis is a chronic inflammatory joint disease that develops in 6% to 48% of the patients with psoriasis. Many patients develop destructive arthritis with bone erosions and loss of joint architecture often leading to loss of joint function. Medical treatment using biologics and conventional immune modulators aims to control inflammation and joint destruction, but damage is rarely undone. Therefore in advanced cases with joint destruction patients may require surgery to restore join function. We performed a crossed sectional analysis of orthopedic interventions in patients with psoriatic arthritis.
Methods A cross-sectional analysis was carried out using the SPAR database at the Rheumatology Department of UZ Leuven, which contains demographic, medical, laboratory, radiological and surgical data of 262 patients with psoriatic arthritis. Basic demographic data were analysed and patients were grouped depending on presence or absence of surgery. Each group was further analysed on the basis of gender, age, mean HAQ score and mean disease duration. The data were statistically analysed using descriptive statistics and Student's t-tests.
Results Out of 262 (158 males and 104 females), 119 (45.41%) of the patients had one or more orthopedic surgical interventions at some point of time. A total of 260 surgical interventions was flagged in the database. Mean age of patients with surgeries was 54.13±11.02 SD and not different from those without surgeries had a mean age of 53.62±12.86 SD (p=0.733). Among all with surgeries 63.02% were males and 36.94% females. Also 40.33% patients underwent single surgery while 59.66% patients underwent multiple surgeries. The type of surgeries included both joint sacrificing and non-joint sacrificing procedures. A significant difference in the mean HAQ score was observed among the patients with surgeries (0.904±0.79 SD) and without surgeries (0.590±0.68 SD) with p value of 0.0006. The mean disease duration at surgery was 2±11.15 SD, 23% of the surgeries were performed after diagnosis whereas 35.76% were performed before patients were diagnosed with psoriatic arthritis. Among the surgeries performed before diagnosis 30% were arthroscopies including 6.54% of diagnostic arthroscopies.
Conclusions This study included data from a single tertiary care center and identified 119 psoriatic arthritis patients with orthopedic surgeries. The number of interventions was increased even with a lower mean disease duration as compared to a similar study on patients with rheumatoid arthritis (Boonen A et al, 2006). There was a significant difference in HAQ score between patients with or without surgeries. Of interest, 35.76% of the orthopedic surgeries were performed before diagnosis including 6.54% of diagnostic arthroscopies. This suggests a need for early diagnosis and treatment in patients with psoriatic arthritis to improve their quality of life.
Disclosure of Interest None declared