Risk of joint surgery in patients with psoriatic arthritis. A register-based time series study from denmark

Background The knowledge is limited about use and time trends of joint surgery among patients with psoriatic arthritis (PsA). It is also unknown whether the need for joint surgery has decreased as seen in most Rheumatoid Arthritis populations in the biologic era.Objectives To study time trends and cumulative incidence of joint surgery among PsA patients in Denmark from 1996 to 2017 compared to a general population cohort (GPC) in a nationwide register-based study.Methods The Danish National Patient Register was used to identify incident PsA patients diagnosed at a department of rheumatology or general internal medicine. We calculated the 5-year incidence rates (IR) and incidence rate ratios (IRR) of joint surgery in 4 calendar-period defined cohorts in Danish PsA patients (1996-2000; 2001-2004; 2005-2008; 2009-2012). Each patient was subsequently matched with up to 10 non-PsA GPCs.Using the Aalen-Johansen estimator, we calculated the 5, 10 and 15-year cumulative incidences of any joint surgery and joint-sacrificing surgery (arthroplasty and arthrodesis), respectively, for all patients PsA patients diagnosed from 1996 to 2017.Results In total, 11 960 PsA patients (mean age 50 years; 57% female) were identified from 1996-2012. The IR of surgery was higher in each PsA calendar cohort compared with their GPC counterpart with an overall IR in PsA of 20.7 (95% CI 19.3-22.1) and GPC 9.9 (95% CI 9.6-10.2) from 1996-2012 (Table 1). Comparing PsA with GPC cohorts across calendar periods, the IRR for any joint surgery decreased slightly from 2.4 (95%CI 2.0 to 2.9) in 1996-2000 to 2.0 (95%CI 1.7 to 2.2) in 2009-2012. Among PsA patients diagnosed between 1996 and 2017, the 5, 10, and 15-year cumulative incidences of surgery were 2%, 10%, and 29%, respectively (Figure 1).Figure 1 Conclusion In this study, the 5-year IR of joint related surgery in PsA did not change substantially from 1996 to 2012. The IR remained about twofold higher compared with the general population. Thus, any beneficial effect of biologics on joint damage has not translated into a clear-cut decreased need for joint sacrificing surgery as observed in several RA populations.After 15 years of follow-up, 29% of the PsA patients had received surgery.View this table:Table 1 Incidence of any joint surgery and joint sacrificing surgery in each calendar period and calculated incidence rate ratios Disclosure of Interests Jørgen Guldberg-Møller Paid instructor for: Abbvie, Eli Lilly, BK Ultrasound., René Cordtz: None declared, Lars Erik Kristensen Grant/research support from: UCB, Biogen, Janssen Pharmaceuticals, and Novartis, Consultant for: Consultant for AbbVie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB Pharma., Speakers bureau: Pfizer, AbbVie, Amgen, UCB, BMS, Biogen, MSD, Novartis, Eli Lilly and Company, and Janssen Pharmaceuticals, Lene Dreyer Consultant for: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: UCB, MSD, Eli Lilly and Janssen Pharmaceuticals.