MUSCULOSKELETAL SURGERY IN PSORIATIC-ARTHRITIS

Objective. To determine the probability that patients with psoriatic a rthritis (PsA) will require musculoskeletal surgery. To identify facto rs predictive of surgery in patients with PsA. To determine the clinic al outcome of patients with PsA who underwent surgery compared to pati ents who did not. Methods, The database of the Psoriatic Arthritis Cli nic was searched to identify individuals who had undergone musculoskel etal surgery. Biological and clinical data such as erythrocyte sedimen tation rate (ESR), rheumatoid factor, clinical pattern, nail changes, functional class, number of inflamed joints, and radiological damage, as well as health scores such as Arthritis Impact Measurement Scale 2 (AIMS-2), SF-36, and Health Assessment Questionnaire (HAQ) were availa ble for these patients. Patients who had surgery were compared to thos e who did not. Results, Out of 444 patients with confirmed PsA, 31 had musculoskeletal surgery (6.98%). This probability increased with the duration of PsA. Surgery patients had their first operation at an aver age of 13.9 years (range 1-46) after onset of joint disease. Age at on set of PsA, clinical pattern, constancy of clinical pattern over time, rheumatoid factor, functional class, symmetry, nail changes, and the time separating the onset of skin disease and the onset of joint disea se were not significantly different at the 0.05 confidence level. Pati ents who had surgery had significantly more radiological damage (p < 0 .001) and more actively inflamed joints (p < 0.02) at first assessment than patients who did not. AIMS2, SF-36, and HAQ scores at final revi ew were not statistically different across both groups. Conclusion. In our patients the probability of having musculoskeletal surgery for Ps A was 7%. It increased with disease duration. Patients had their first surgery after an average of 13 years. The number of actively inflamed joints and the extent of radiological damage at first assessment were highly predictive of subsequent surgery: patients with the highest nu mbers of severely affected joints, both clinically and radiologically, were more likely to have surgery. ''Baseline characteristics'' such a s ESR, rheumatoid factor, functional class, clinical pattern, nail cha nges, and symmetry were not predictive of subsequent orthopedic surger y.