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Five-year rate for joint surgery in PsA twice as high as general population
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A patient diagnosed with psoriatic arthritis at 18 to 40 years of age carries a greater risk for joint surgery than someone aged 60 years or older in the general population, according to findings published in Annals of the Rheumatic Diseases.
“The options for treating patients with psoriatic arthritis have multiplied the last decade with the introduction of biological treatment,” Jørgen Guldberg-Møller, MD, of Copenhagen University Hospital in Denmark, told Healio Rheumatology. “Furthermore treat-to-target strategies have been gradually implemented. We sought to learn if the need for joint surgery was impacted by these new approaches to treatment over time.”
To evaluate the time trends and incidence of joint surgery among patients with PsA, compared with the general population, Guldberg-Møller and colleagues studied data from the Danish National Patient Registry. The researchers identified 11,960 patients in the registry diagnosed with PsA from 1996 to 2017, and matched each to 10 individuals without PsA from the general population based on age, sex and municipality.
The primary outcome was the occurrence of first joint surgery. Secondary outcomes included joint-sacrificing and nonjoint-sacrificing surgery of the upper and lower extremities. The researchers calculated the 5-year incidence rates and incidence rate ratios across four calendar periods — 1996 to 2000, 2001 to 2004, 2005 to 2008 and 2009 to 2012. In addition, they used the Aalen-Johansen method to estimate the cumulative incidences of any joint, and joint-sacrificing surgery.
According to the researchers, the incidence rate ratios of any joint surgery were twice as high for patients with PsA than for individuals in the general population for all four calendar periods. Among patients with PsA, 2% required joint surgery at 5 years following diagnosis, 10% required it after 10 years and 29% required joint surgery at after 15years. In addition, the researchers found that the cumulative incidence of any joint surgery after 15 years of follow-up was 22% among patients with PsA diagnosed at 18 to 40 years of age, compared with 20% among individuals in the general population aged 60 years and older.
“Using data from more than 10,000 patients with psoriatic arthritis compared with more than 100,000 from the general population, we demonstrated that the need of joint surgery was twice as high in patients with psoriatic arthritis and did not change substantially from 1996 to 2012,” Guldberg-Møller said. “Clinicians should be aware of high joint related surgical rates in patients with psoriatic arthritis and implement a treat-to-target strategy early after diagnosis.” – by Jason Laday
Disclosure: Guldberg-Møller reports speaking fees from AbbVie, Eli Lilly and BK Ultrasound. See the full study for additional authors’ disclosures.
Perspective
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Psoriatic arthritis is a common inflammatory arthritis that classically occurs in persons with psoriasis. It has been recognized that a large proportion of patients with PsA may develop an aggressive, destructive arthritis; however, it remains unclear if the impact of biologic DMARDs has led to a decreased need for joint surgery in PsA as has been demonstrated in rheumatoid arthritis.
This Danish nationwide registry-based study by Guldberg-Moller and colleagues showed that the cumulative incidence of any joint surgery among patients with PsA was 1.7%, 10.4%, 28.9% after 5, 10, and 15 years respectively — which was double that of individuals in the general population cohort at any given calendar period. Of further interest, patients with PsA in the 18-40 year old cohort had a higher incidence rate of joint surgery than those in the general population aged 60 years and older at 15 years.
This study illustrates a significant health burden associated with PsA and underscores the need to implement aggressive treat-to-target strategies in order to prevent erosive disease and loss of joint function, which may lead to either joint sacrificing or non-joint sacrificing surgeries. Additionally, this study serves as a basis for future studies to assess the impact of biologic DMARD therapy on reducing the incidence rates of joint surgeries in the psoriatic arthritis population.
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