Incidence and Predictive Factors for Orthopedic Surgery in Patients with Psoriatic Arthritis

Nystad, Tone Wikene; Husum, Yngvil Solheim; Furnes, Ove; Fevang, Bjørg‐Tilde Svanes

doi:10.3899/jrheum.180203

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…Our observed high surgical rates at a population level is in alignment with an observational study from Norway by Nystad et al ,17 which do not detect a decrease in joint surgery even after the introduction of bDMARDS in 1999. It was speculated that it was too early to identify a change in surgical prognosis in patients in their cohort diagnosed from 1999 and onward.…”

Section: Discussionsupporting

confidence: 92%

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Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark

et al. 2019

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ObjectiveTo investigate time-trends and cumulative incidence of joint surgery among patients with psoriatic arthritis (PsA) compared with the general population.MethodsIn this nationwide register-based cohort study, The Danish National Patient Registry was used to identify incident PsA patients. The 5-year incidence rates (IR) and incidence rate ratios (IRR) of joint surgery were calculated in four calendar-period defined cohorts. Each patient was matched with ten non-PsA individuals from the general population cohort (GPC). The cumulative incidences of any joint and joint-sacrificing surgery, respectively, were estimated using the Aalen-Johansen method.ResultsFrom 1996 to 2017, 11 960 PsA patients (mean age 50 years; 57% female) were registered. The IRR of any joint surgery was twice as high for PsA patients compared with GPCs across all calendar periods. Among patients with PsA, 2, 10 and 29% required joint surgery at 5, 10 and 15 years after diagnosis. The risk of surgery in PsA patients diagnosed at 18–40 years was higher (22%) than in GPC 60+ year old (20%) after 15 years of follow-up.ConclusionsThe use of joint surgery among PsA patients remained around twofold higher from 1996 to 2012 compared with GPC. After 15 years of follow-up, nearly 30% of the PsA patients had received any surgery, and even a person diagnosed with PsA at the age of 18–40 years had a higher risk of surgery than GPCs of 60+ year old. Thus, the high surgical rates represent an unmet need in the current treatment of PsA.

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Section: Discussionsupporting

confidence: 92%

“…Lewinson et al found a paradoxical increase in surgery following the introduction of bDMARDs in the UK 16. Nystad et al did not detect a reduced need for surgery in Norwegian PsA patients prescribed bDMARDS and the risk of joint surgery was the same regardless if patients were diagnosed in 1985 or 1998 17…”

Section: Introductionmentioning

confidence: 99%

Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark

et al. 2019

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“…Differential diagnosis is sometimes complex and early management is di cult, requiring the aid of a rheumatologist. There are many studies underlying the delay in diagnosis and treatment of PsA, which typically leads to different orthopedic operations until these patients nally are diagnosed (12,13).…”

Section: Discussionmentioning

confidence: 99%

Specialized Dermatological - Rheumatological Patient Management Improves Diagnostic Outcome and Patient Journey: A Four-Year Analysis

Ziob

Behning

Brossart

et al. 2021

Preprint

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Background:Management of psoriatic arthritis (PsA) and other rheumatological diseases requires an interdisciplinary approach involving dermatologists and rheumatologists. The aim of the study was to analyze the specialized dermatological-rheumatological management before and after foundation of a PsA center. Methods:A retrospective cohort study of all dermatology-rheumatology consultations during two periods was conducted. Period one, from April 1st, 2016 to February 28th, 2018 versus period two, from March 1st, 2018 to January 31st, 2020, after foundation of a PsA center. Clinical data on patient characteristics including psoriasis subtypes, clinical symptoms and signs, disease activity scores, classification criteria and comorbidities as well as patient journey were extracted and analyzed.Results: 404 consultations were studied. Close collaboration in a PsA center lead to a relevantly shortened patient journey concerning rheumatological complaints: period 1: median (IQR): 36.0 (10.0-126.0) months, period 2: median (IQR): 24.0 (6.0-60.0) months. Established scores and classification criteria such as GEPARD or CASPAR did not assist in diagnosis of PsA. Arthralgia (p=0.0407), swollen joints (p=0.0151), morning stiffness (p=0.0451) and dactylitis (p=0.0086) helped to distinguish between osteoarthritis and PsA.Conclusions: Clinical signs and symptoms, scores and classification criteria usually assessed were less helpful than expected in diagnosis of PsA and other rheumatological diseases. Close collaboration in a specialized PsA center yielded the fastest way of diagnosis.

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“…Left untreated, PsA can lead to a chronic debilitating illness and therefore cause immobility as well as overall well‐being issues (Strauss, Alfonso, Baidwan, & Di Cesare, 2008). Differential diagnosis is difficult and early management of PsA significantly improves the loss of function and quality of life of patients, as well as achieve control of the structural changes of bone and cartilage (Nystad, Husum, Furnes, & Fevang, 2018) There are several reports underlying the delay between development of PsA symptoms and diagnosis, which usually leads to various orthopedic, surgical operations, before actually these patients receive the right therapeutic agent (Nystad et al, 2018; Strauss et al, 2008). Previous studies also suggest that there are remarkable deviations in clinical handling and follow‐up of Pso and PsA patients, depending on the specialist they choose to initially see, and this often leads to misdiagnosis and loss of compliance (Cobo‐Ibáñez et al, 2016; Luchetti et al, 2018; Yélamos, Ros, & Puig, 2015).…”

Section: Discussionmentioning

confidence: 99%

How does the joint dermatology–rheumatology clinic benefit both patients and dermatologists?

Theodorakopoulou

Katsimbri

Boumpas

et al. 2020

Dermatologic Therapy

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Psoriasis (Pso) and psoriatic arthritis (PsA) are chronic and debilitating diseases which often develop in the same patient and are linked to a wide range of comorbid conditions. Dermatologists and rheumatologists need to cooperate in combined clinics, especially when they deal with severe, recalcitrant disease, and multiple comorbidities. The clinical and research benefits of this collaboration have been previously described to contribute to a better and more sustainable health care system. To apply a more holistic approach of patients with Pso and PsA, we established the first dual care clinic in Greece, for Pso and PsA patients, based at Attikon General University Hospital. Hereby, we describe the infrastructure and operation of a combined Pso and PsA clinic (PPAC), in the national health care system of Greece, and its impact on the management of Pso and PsA. The PPAC is a single‐day joint clinic, held once a week, which consists of three dermatologists and three rheumatologists. We present the results of 185 newly diagnosed patients between December 2018 and January 2019. Mean age of onset of Pso was 34 ± 16 years old and 47 ± 12 years old for PsA. Most patients suffered from severe plaque Pso (144/185, 78%) and asymmetric oligoarticular arthritis (59/185, 32%), for which they were receiving treatment with biologic agents (105/185, 57%). Many required monitoring for hypertension (74/185, 40%), dyslipidemia (69/185, 37%), diabetes (17/185, 9%), and depression (20/185, 11%). Patients reported high levels of care satisfaction (visual analogue scale: 86 ± 11.5), using the PPAC facility, compared to different referrals between specialties. This is the first joint dermatology–rheumatology clinic in Greece, providing comprehensive care in patients with Pso and PsA. Our results support the concept of combined clinics delivering better integrated care for such patients.

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Incidence and Predictive Factors for Orthopedic Surgery in Patients with Psoriatic Arthritis

Abstract: There were 20% of patients with PsA who needed surgery. We found that the prognosis of patients with PsA did not change regarding the risk of orthopedic surgery, despite the change in treatment. A possible explanation is the increase in large joint replacements in the general population.

Cited by 11 publications

References 31 publications

Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark

Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark

Specialized Dermatological - Rheumatological Patient Management Improves Diagnostic Outcome and Patient Journey: A Four-Year Analysis

How does the joint dermatology–rheumatology clinic benefit both patients and dermatologists?

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