Musculoskeletal Surgery in Psoriatic Arthritis: Prevalence and Risk Factors

Abstract

ObjectiveDespite medical therapy damage occurs in PsA patients requiring musculoskeletal (MSK) surgery. We aimed to describe MSK surgery in PsA patients and identify risk factors for undergoing first MSK surgery attributable to PsA.MethodsA single-center cohort identified PsA patients fulfilling CASPAR criteria who had MSK surgery from January 1978 to December 2019 inclusive. Charts were reviewed to confirm surgeries were MSK-related and attributable to PsA. Descriptive statistics determined MSK surgery prevalence and types. Cox proportional-hazards models evaluated clinical parameters for undergoing first MSK surgery using time-dependent covariates. Using a dataset with one-to-one matching on markers of PsA disease severity, a Cox proportional-hazards model evaluated the impact of targeted therapies, namely biologics on time to first MSK surgery.ResultsOf 1574 patients, 185 patients had 379 MSK surgeries related to PsA. The total number of damaged joints (HR 1.032,p< 0.001), tender/swollen joints (HR 1.037,p= 0.007), presence of nail lesions (HR 2.079,p< 0.006), higher Health Assessment Questionnaire scores (HR 2.012, p < 0.001), elevated erythrocyte sedimentation rate (HR 2.365,p= 0.017) and HLA-B*27 positivity (HR 2.217,p= 0.048) were associated with increased risk of surgery, while higher Psoriasis Area Severity Index (HR 0.881,p< 0.002) conferred a protective effect in a multivariate model. The effect of biologics did not reach statistical significance.ConclusionMSK surgery attributable to PsA is not rare, affecting 11.8% of patients. Markers of cumulative disease activity and damage are associated with a greater risk of requiring surgery.

The impact of psychological interventions on surgical site wound healing post‐surgery in psoriasis patients: A meta‐analysis

“…The outcome of this process was the careful selection of 6 key studies [9][10][11][12][13][14] for inclusion in our meta-analysis, as depicted in Figure 1. A comprehensive overview of the study characteristics and surgical site wound healing metrics is presented in Table 1.…”

“…A stringent two‐tiered exclusion process then followed: 254 records were first excluded on the basis of title and abstract assessments, subsequently followed by the exclusion of an additional 92 records upon detailed full‐text review for not conforming to the pre‐established inclusion criteria. The outcome of this process was the careful selection of 6 key studies 9–14 for inclusion in our meta‐analysis, as depicted in Figure 1. A comprehensive overview of the study characteristics and surgical site wound healing metrics is presented in Table 1.…”