Risk of joint surgery is increased in people with psoriatic arthritis

Current treatments seem not to have reduced the long-term need for joint surgery in people with psoriatic arthritis.

Introduction
Psoriatic arthritis (PsA for short) is a chronic inflammatory disease affecting a person’s joints and other parts of the body, including the spine, skin, and tissues joining tendons and ligaments to bones (called entheses). It gets its name from the link between this type of arthritis and a skin condition called psoriasis, which causes red, flaky, crusty patches of skin covered with silvery scales. The inflammation in psoriatic arthritis often causes swelling of the fingers, toes or bigger joints (such as the knee). This can result in pain, fatigue, and mobility issues, among other symptoms. As a result, psoriatic arthritis can affect people’s quality of life, which is a
measure of a person’s physical, mental, emotional and social wellbeing.

In time, many people with psoriatic arthritis will experience bone loss and breakdown (known as erosive arthritis), and joint surgery may be needed.

What did the authors hope to find?
The authors hoped to show that medical treatment of people with psoriatic arthritis has reduced the need for joint replacement to the same level as the general population.

Who was studied?
The study included nearly 12,000 people with psoriatic arthritis in Denmark. The need for joint surgery in people with psoriatic arthritis was compared with people from the general population who were the same age, sex and lived in the same area. The average age of people in the study was 50 years, and 57% of those taking part were female.

How was the study conducted?
The authors used existing databases of patient records to look back and find people for each group. These databases were the Danish National Patient Registry and the Civil Registration System. Information from these databases meant they could work out the rates of joint surgery in both groups of people over a period from 1996 to 2017. There were no experimental treatments given.

What were the main findings of the study?
The study showed that the rate of joint surgery in people with psoriatic arthritis was twice as high as in the general population. It did not change much from 1996 to 2012.

The study also showed that after 15 years of follow-up, 29% of the people with psoriatic arthritis needed joint surgery. Even relatively young people diagnosed with psoriatic arthritis between the ages of 18 to 40 years had a higher risk of needing joint surgery than someone over the age of 60 in the general population.

Are these findings new?
Yes, these findings are new, and they highlight an important issue for people with psoriatic arthritis. They also suggest that the need for joint surgery should be included as a measure in future studies of psoriatic arthritis.

What are the limitations of the study?
The study design did not allow the authors to take into account risk factors for surgery, such as osteoarthritis and fractures. In addition, they did not have access to information on people’s body mass index, which can influence the need for joint surgery. However, the need for surgery in people with psoriatic arthritis compared to the general population in this study is somewhat greater. Even though the reason for surgery in some people may have been osteoarthritis, joint damage due to other kinds of inflammatory arthritis, or trauma, the high rates of joint surgery in people with psoriatic arthritis is an important issue.

What do the authors plan on doing with this information?
These results suggest that treatments have not reduced the need for joint replacement in people with psoriatic arthritis to the same level as the general population. The authors want to emphasise the need for an early medical treat-to-target strategy where the target, in this case, is no joint swelling, no inflammation in the finger and toe joints, or swollen tendons as signs of disease activity.

This study did not split the results out by specific types of treatment that people had received. The authors are planning a new study to look at the impact of biological treatments on the need for joint surgery in people with psoriatic arthritis.

What does this mean for me?
If you have psoriatic arthritis, you are more at risk of needing joint surgery than someone of the same age without the disease. Future studies might help to show which treatments can reduce the risk.

Staying well and healthy can help to protect your joints. This includes taking your treatment as prescribed, eating well, and taking appropriate exercise to strengthen and mobilise your joints.

If you have any concerns about your disease or its treatment, you should talk to a healthcare professional.

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Date prepared: October 2019
Summary based on research article published on: 12 July 2019
From: Guldberg-Møller J, et al. Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark. Ann Rheum Dis 2019;78:1517–1523. doi:10.1136/ annrheumdis-2019-215313

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