Nearly 12% of Patients With PsA Need Musculoskeletal Surgery


Among adults with psoriatic arthritis (PsA), 11.8% required at least one musculoskeletal surgery related to their disease, based on data from more than 1,500 individuals at the University of Toronto’s Psoriatic Arthritis Clinic.

“Despite optimal medical therapy to control systemic inflammation and preserve joint function, a subset of patients with PsA still require musculoskeletal (MSK) surgery for disease-related morbidity,” but data on the prevalence of MSK surgeries and the associated risk factors are lacking, wrote Timothy S.H. Kwok, MD, of the University of Toronto, and colleagues.

In a study published in The Journal of Rheumatology, the researchers reviewed data from a longitudinal cohort of 1,574 adults aged 18 years and older with PsA established at the Toronto clinic during 1978-2019.


Overall, 185 patients had 379 MSK surgeries related to PsA during the study period for a prevalence of 11.8%.

The most common procedures were arthrodesis and arthroplasty (27% for both). More than half (59%) of the surgeries were joint sacrificing, and 41% were joint retaining, and 57 procedures were revisions related to the primary surgery.

Among 1,018 patients with data complete enough for a multivariate analysis, including 71 PsA surgeries, factors significantly associated with an increased risk for surgery were a higher number of damaged joints (hazard ratio [HR], 1.03; P < .001), tender or swollen joints (HR, 1.04; P = .01), and the presence of nail lesions (HR, 2.08; P < .01). Other predictors of surgery were higher scores on the Health Assessment Questionnaire (HR, 2.01; P < .001), elevated erythrocyte sedimentation rate (HR, 2.37; P = .02), and HLA-B27 positivity (HR, 2.22; P = .048).

However, a higher score on the Psoriasis Area Severity Index was significantly associated with lower risk of surgery (HR, 0.88; P < .002) The use of biologics had no significant impact on MSK surgery, the researchers noted.

The high percentage of joint sacrificing surgeries suggests a high burden of MSK surgery in patients with PsA, the researchers wrote in their discussion. The current study supports findings from previous studies and highlights the potential limitations and need for improvement in the current medical treatment paradigm for PsA, they said.

The findings were limited by several factors, including the potential for referral bias of complex cases to the center, which might have caused overestimation of the number of surgeries. The similarity in surgeries specifically related to PsA and degenerative arthritis also makes overestimation of surgeries possible, the researchers noted.

However, the study is one of the largest known to evaluate the prevalence of risk factors for MSK surgery in PsA patients over a long period of time, and identified surgeries directly attributable to PsA, they said. The study ended prior to the onset of the COVID-19 pandemic, which increased the external validity of the findings, they added.

The study was supported by the Krembil Foundation. The researchers had no financial conflicts to disclose.

This article originally appeared on, part of the Medscape Professional Network.

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