Hospital for Special Surgery, New York, New York.
Arthritis Rheumatol. 2016 Feb;68(2):410-7. doi: 10.1002/art.39431.
Outcomes of total hip arthroplasty (THA) in patients with psoriasis have been poorly studied. This study was undertaken to assess whether patients with psoriatic arthritis (PsA) or those with cutaneous psoriasis (PsC) without evidence of inflammatory joint disease are at an increased risk for worse outcomes after THA as compared to patients with osteoarthritis (OA).
Among subjects in a prospective THA registry, PsA and PsC cases were identified by International Classification of Diseases, Ninth Revision codes, and all cases were matched with patients with OA as controls. Analyses were performed to identify predictors of poor postoperative pain or function.
Of the 289 potential cases of PsA or PsC, 63 with PsA and 153 with PsC were validated. Self-report data were available postoperatively from 75% of PsA patients, 69% of PsC patients, and 94% of OA controls. In total, 51% of PsA patients and 56% of PsC patients were male, compared to 45% of OA controls (P = 0.04). Body mass index was higher in those with PsA or PsC (P = 0.002 versus controls). There were no differences in race or education between the 3 groups. PsA patients and PsC patients had more comorbidities than OA controls. PsA patients were more likely than PsC patients and OA controls to be current or previous smokers. Moreover, 54% of PsA patients were being treated with biologics or nonbiologic disease-modifying antirheumatic drugs, compared to 8% of PsC patients. There were no significant differences in pre- or postoperative Western Ontario and McMaster Universities OA Index scores for pain or function between the 3 groups. Short-Form 36 mental component summary scores were significantly better in the OA controls, both pre- and postoperatively (P = 0.006 and P < 0.001, respectively, versus PsA or PsC). EuroQol 5-domain health-related quality of life scores were significantly worse postoperatively for those with PsA or PsC (P < 0.0001 versus OA controls). In regression analyses, neither PsA nor PsC were risk factors for worse THA outcomes. Satisfaction with the outcomes of THA was similarly high among all 3 groups (P = 0.54).
Neither PsA nor PsC are risk factors for poor outcomes after THA. This is important information to convey to patients with either PsA or PsC who are contemplating surgical intervention with THA.
患有银屑病的全髋关节置换术（THA）患者的结局研究甚少。本研究旨在评估患有银屑病关节炎（PsA）或无炎症性关节病证据的皮肤银屑病（PsC）的患者与骨关节炎（OA）患者相比，THA 后结局较差的风险是否增加。
在一项前瞻性 THA 登记研究中，通过国际疾病分类，第九版代码确定 PsA 和 PsC 病例，所有病例均与 OA 患者作为对照组进行匹配。进行分析以确定术后疼痛或功能不良的预测因素。
在 289 例潜在的 PsA 或 PsC 病例中，有 63 例 PsA 和 153 例 PsC 得到了验证。75%的 PsA 患者、69%的 PsC 患者和 94%的 OA 对照组患者术后可获得自我报告数据。总体而言，51%的 PsA 患者和 56%的 PsC 患者为男性，而 OA 对照组为 45%（P=0.04）。与对照组相比，患有 PsA 或 PsC 的患者的体重指数更高（P=0.002）。3 组之间在种族或教育程度方面没有差异。PsA 患者和 PsC 患者比 OA 对照组有更多的合并症。与 PsC 患者和 OA 对照组相比，PsA 患者更有可能是当前或以前的吸烟者。此外，54%的 PsA 患者正在接受生物制剂或非生物疾病修饰抗风湿药物治疗，而 PsC 患者仅为 8%。3 组之间术前和术后的安大略西部和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC）评分的疼痛或功能均无显著差异。术前和术后的 36 项简明健康调查问卷（Short-Form 36，SF-36）精神成分综合评分均在 OA 对照组中显著改善（分别为 P=0.006 和 P<0.001，均与 PsA 或 PsC 相比）。EuroQol 5 维健康相关生活质量评分在 PsA 或 PsC 患者中术后明显更差（P<0.0001，与 OA 对照组相比）。回归分析显示，PsA 和 PsC 均不是 THA 结局不良的危险因素。3 组患者对 THA 结局的满意度均较高（P=0.54）。
PsA 和 PsC 均不是 THA 后不良结局的危险因素。这对于考虑接受 THA 手术干预的 PsA 或 PsC 患者来说是一个重要的信息。
