Zangger P, Gladman D D, Bogoch E R
Hôpital Orthopédique, University of Lausanne, Switzerland.
J Rheumatol. 1998 Apr;25(4):725-9.
To determine the probability that patients with psoriatic arthritis (PsA) will require musculoskeletal surgery. To identify factors predictive of surgery in patients with PsA. To determine the clinical outcome of patients with PsA who underwent surgery compared to patients who did not.
The database of the Psoriatic Arthritis Clinic was searched to identify individuals who had undergone musculoskeletal surgery. Biological and clinical data such as erythrocyte sedimentation rate (ESR), rheumatoid factor, clinical pattern, nail changes, functional class, number of inflamed joints, and radiological damage, as well as health scores such as Arthritis Impact Measurement Scale 2 (AIMS-2), SF-36, and Health Assessment Questionnaire (HAQ) were available for these patients. Patients who had surgery were compared to those who did not.
Out of 444 patients with confirmed PsA, 31 had musculoskeletal surgery (6.98%). This probability increased with the duration of PsA. Surgery patients had their first operation at an average of 13.9 years (range 1-46) after onset of joint disease. Age at onset of PsA, clinical pattern, constancy of clinical pattern over time, rheumatoid factor, functional class, symmetry, nail changes, and the time separating the onset of skin disease and the onset of joint disease were not significantly different at the 0.05 confidence level. Patients who had surgery had significantly more radiological damage (p < 0.001) and more actively inflamed joints (p < 0.02) at first assessment than patients who did not. AIMS2, SF-36, and HAQ scores at final review were not statistically different across both groups.
In our patients the probability of having musculoskeletal surgery for PsA was 7%. It increased with disease duration. Patients had their first surgery after an average of 13 years. The number of actively inflamed joints and the extent of radiological damage at first assessment were highly predictive of subsequent surgery: patients with the highest numbers of severely affected joints, both clinically and radiologically, were more likely to have surgery. "Baseline characteristics" such as ESR, rheumatoid factor, functional class, clinical pattern, nail changes, and symmetry were not predictive of subsequent orthopedic surgery.
确定银屑病关节炎（PsA）患者需要进行肌肉骨骼手术的概率。识别PsA患者手术的预测因素。确定接受手术的PsA患者与未接受手术的患者相比的临床结局。
检索银屑病关节炎诊所的数据库，以识别接受过肌肉骨骼手术的个体。这些患者可获得生物和临床数据，如红细胞沉降率（ESR）、类风湿因子、临床模式、指甲变化、功能分级、炎症关节数量和放射学损伤，以及健康评分，如关节炎影响测量量表2（AIMS-2）、SF-36和健康评估问卷（HAQ）。将接受手术的患者与未接受手术的患者进行比较。
在444例确诊的PsA患者中，31例接受了肌肉骨骼手术（6.98%）。这种概率随PsA病程的延长而增加。手术患者在关节疾病发作后平均13.9年（范围1 - 46年）进行首次手术。在0.05的置信水平下，PsA发病年龄、临床模式、临床模式随时间的稳定性、类风湿因子、功能分级、对称性、指甲变化以及皮肤病发作与关节病发作之间的时间间隔无显著差异。与未接受手术的患者相比，接受手术的患者在首次评估时放射学损伤显著更多（p < 0.001），炎症关节更活跃（p < 0.02）。两组在最终复查时的AIMS2、SF-36和HAQ评分无统计学差异。
在我们的患者中，PsA进行肌肉骨骼手术的概率为7%。它随病程延长而增加。患者平均在13年后进行首次手术。首次评估时炎症活跃关节的数量和放射学损伤程度高度预测后续手术：临床和放射学上受影响最严重关节数量最多的患者更有可能接受手术。诸如ESR、类风湿因子、功能分级、临床模式、指甲变化和对称性等“基线特征”不能预测后续骨科手术。
