Type and outcome of reconstructive surgery for different patterns of psoriatic arthritis

Objective. To describe our experience of musculoskeletal surgery in patient s with different patterns of psoriatic arthritis (PsA). Methods, From 1986 to 1996, 71 operations in 43 patients with established P sA were performed at our institution. The patterns of PsA recognized in thi s patient group were: distal PsA, oligoarticular PsA, and polyarticular PsA , with or without associated spondylitis. Surgical findings and procedure, intra- and postoperative complications were recorded. Nineteen patients wer e available for clinical evaluation, both by conventional surgeon generated and by patient generated self-administered questionnaires. Results. The majority of patients had polyarticular PsA. All operations in patients with distal PsA were distal interphalangeal (DIP) and proximal int erphalangeal (PIP) joint fusions. All operations in patients with oligoarti cular PsA involved the hip or knee. Polyarticular patients underwent a rang e of procedures. Soft tissue contractures and bone loss required specific a ttention in 14 procedures. In the 19 patients who were reviewed clinically, conventional scoring of individual procedures showed good to excellent res ults. Patient oriented outcomes had low scores compared to a disease-free g eneral population. Conclusion. The 3 principal patterns of PsA are associated with different t ypes of surgery. Although traditional surgeon generated scores evaluating i ndividual procedures indicated results comparable to patients who have oste oarthritis, patient generated outcome measures of global health and functio n scored substantially lower than a general, arthritis-free population, ref lecting the burden of polyarticular involvement.