Musculoskeletal surgery not uncommon in psoriatic arthritis

Psoriatic arthritis (PsA) that requires musculoskeletal (MSK) surgery affects more than one in 10 patients (11.8 percent), reveals a study, adding that markers of cumulative disease activity and damage are associated with a greater need for a surgical procedure.

Patients with PsA who met the Classification Criteria for Psoriatic Arthritis and underwent MSK surgery between January 1978 and December 2019 were included in a single-centre cohort. A chart review was conducted to determine if surgeries were MSK-related and attributable to PsA. Descriptive statistics were employed to assess the prevalence and types of MSK surgery.

The investigators used Cox proportional hazards models, with time-dependent covariates, to examine the clinical variables for undergoing first MSK surgery. In addition, they used a dataset with 1-to-1 matching on markers of PsA disease activity to examine the effect of targeted therapies, particularly biologics on time to first MSK surgery.

A total of 1,574 patients were identified, of whom 185 had 379 PsA-related MSK surgeries.

In a multivariate model, a higher risk of surgery was associated with the total number of damaged joints (hazard ratio [HR], 1.03; p<0.001), tender/swollen joints (HR, 1.04; p=0.01), presence of nail lesions (HR, 2.08; p<0.01), higher Health Assessment Questionnaire scores (HR, 2.01; p<0.001), elevated erythrocyte sedimentation rate (HR, 2.37; p=0.02), and HLA-B27 positivity (HR, 2.22; p=0.048).

On the other hand, a higher score in the Psoriasis Area Severity Index (HR, 0.88; p<0.001) was associated with a protective benefit.

Unfortunately, the effect of biologic therapy did not reach statistical significance, according to the investigators.