From healthcentral.com
If medications aren’t relieving your symptoms, your doctor may talk with you about surgical options. Here’s what you should know
When you’re living with psoriatic arthritis (PsA), a type of inflammatory arthritis, you know all about the way symptoms can develop slowly or progress quickly. You may experience fatigue, tenderness, pain, and swelling around the joints, swollen fingers and toes, joint stiffness, and a reduced range of motion—all at once or over a period of time.
Medications for PsA typically target the overactive immune system that is the cause of the condition. But because there is no definitive test to determine if someone has psoriatic arthritis, a delay in a diagnosis often means someone has permanent joint damage by the time they’re diagnosed. And in those cases, while surgery isn’t common for psoriatic arthritis, it may be recommended to you. Our experts explain when psoriatic arthritis surgery is worth considering and what the drawbacks may be.
When Is PsA Surgery Needed?
According to Daniel Polatsch, M.D., co-director of the Hand and Wrist Center at Northwell Health’s Manhattan Eye, Ear and Throat Hospital in New York City, surgery for psoriatic arthritis is typically considered a last resort after medications and therapy fail to adequately manage symptoms.
Dee Dee Wu, M.D., a rheumatologist at the Hospital for Special Surgery in New York City agrees, explaining that with the systemic treatment available for psoriatic arthritis today, surgery doesn’t play as big of a role in treatment as it once did. “However, there are circumstances where someone may have gone a long time without an accurate psoriatic arthritis treatment or maybe there was undertreated disease for an extended period, leading to uncontrolled disease and joint damage over time,” Dr. Wu says.
In addition, not every treatment works for every patient: According to a 2024 review, despite the new treatment options for psoriatic arthritis, typically fewer than 40% of people achieve a state of minimal disease activity on consecutive doctor visits.
Types of Psoriatic Arthritis Surgery
“The types of surgeries I most often see related to psoriatic arthritis involve joint preservation or reconstruction procedures in the hands and wrists,” says Dr. Polatsch. “Common interventions include synovectomy or removal of inflamed joint lining, tendon repair or reconstruction due to ruptures from chronic inflammation, and joint fusion or replacement for joints severely damaged by the disease.”
The goal of surgery is simple: “These procedures aim to reduce pain, improve function, and prevent further deformity when conservative treatments are no longer effective,” says Dr. Polatsch.
Synovectomy
Synovectomy is an operation to remove the synovium (the lining of the joints). This may reduce pain, swelling and joint damage. However, the synovium may regrow after several years, and the symptoms can return. According to the Hospital for Special Surgery, some people require only a partial synovectomy, with a smaller amount of tissue removed.
Arthrodesis
Also known as joint fusion, this surgery involves fusing together the two bones that form the joint. Since the joint can no longer be moved, it is no longer as painful. According to the Arthritis Foundation, arthrodesis is commonly used to treat arthritis pain in the joints near the ends of the fingers. This type of surgery is known to improve function with the absence of pain, but there will be reduced mobility post-surgery.
Arthroplasty
Arthroplasty is also called joint replacement surgery. This involves replacing the damaged joint with an artificial joint. Joint replacements can be done on knees, hips, shoulders, toes and fingers, and ankles. According to a 2024 study, people with psoriatic arthritis have a greater risk of having a total knee or hip replacement surgery compared to the general population.
How to Know if Surgery Is Needed
Whether or not surgery is needed will be a shared decision made with your rheumatologist, orthopaedic surgeon, and you. A major consideration, says Dr. Wu, is whether better or different medication might address your psoriatic arthritis pain, rather than surgical intervention. “It can be confusing to determine when surgery is needed for someone with more than one condition, for example if someone is older in age and has osteoarthritis as well as psoriatic arthritis, it can be up to the rheumatologist to determine if the joint should be managed medically or surgically,” she explains.
That scenario is more common than you might think. “It’s not uncommon that someone has knee pain and has osteoporosis along with psoriatic arthritis,” Dr. Wu adds. This is where the rheumatologist can use their detective skills to determine if surgery is beneficial. To start, your rheumatologist may remove fluid from the joint in question and run it through lab tests. If the white cell count is elevated without another infection in the body, this may point toward the inflammation being triggered by inflammatory problem like psoriatic arthritis. “It’s important to test the joint fluid if surgery is being considered,” she says.
An MRI is another important tool to determine the amount of damage to your joint. Taken together with a clinical exam, MRIs help your doctor evaluate whether surgery could help ease your pain. “For example, the rheumatologist will want to know if the knee is stiffer in the morning or if it seems to hurt more with activity—if it seems to hurt more with activity, this could indicate a degenerative problem that can be helped with surgery,” Dr. Wu explains.
Risks and Benefits of Psoriatic Surgery
There are potential setbacks and complications to consider before you have surgery with psoriatic arthritis, says Dr. Wu. “If you are on an immune suppressant medication, you may have a higher risk of infection, so you will most likely need to stop and then restart the medication after surgery,” she says. But while stopping the immune suppressant medication can reduce your risk of infection, it may also increase your risk for a flare in your psoriatic arthritis, something you and your doctor will want to discuss.
If you are a good candidate for surgery, it may be worth the risks. One study found psoriatic arthritis patients who had a total hip replacement achieved similar improvements in pain and functional status compared to those seen in osteoarthritis patients after the same surgery. Satisfaction with the outcomes of the surgery was also similar between the two groups.
What to Expect Before and After Psoriatic Arthritis Surgery
Before surgery, it is important that your psoriatic disease activity is minimal, says Dr. Wu. “There is also an increased cardiovascular risk with psoriatic arthritis patients, so they will need to be cleared by a cardiologist before surgery,” she says.
Physical therapy will be required after most surgeries to restore movement and function, but for best outcomes, you should start focusing on your physical fitness prior to any procedure. “Recovery from surgery could be harder if someone with psoriatic arthritis is frail from having a bad joint and is not really active going into the surgery,” Dr. Wu explains.
Bottom Line
Early and aggressive psoriatic arthritis treatment via medication that controls inflammation has reduced the need for surgery in recent times. However, if finding the right treatment has been a long process, joint damage may have occurred and surgery may be needed as a result.
Before scheduling surgery, it is important that your rheumatologist is working closely with your orthopaedic surgeon to double check that pain and disfunction is the result of joint deterioration and not active psoriatic arthritis inflammation. If you do require surgery, working closely with your rheumatologist to develop a pre and post operative plan can help you achieve the best results.
No comments:
Post a Comment