Psoriatic Arthritis and Arthroplasty

Psoriatic arthritis is an inflammatory arthropathy associated with the characteristic dermatologic lesions of psoriasis. The diagnosis of psoriatic arthritis is quite difficult, due to the overlap of patients with osteoarthritis (OA) or rheumatoid arthritis (RA) with concomitant non-associated psoriasis. A nonspecific elevation in inflammatory markers (erythrocyte sedimentation rate, ESR; antinuclear antibodies, ANA; or rheumatoid factor, RF) and characteristic radiographic features are often present in these patients. The mainstay of treatment is medical management, using NSAIDs, various immunosuppressants, and anti-TNF agents, for both pain control and possibly as disease modifying agents. Only a minority of patients require surgical intervention, leading to the limited amount of literature concerning total joint arthroplasty and psoriatic arthritis. While past literature has yielded high infection rates post-arthroplasty, newer studies have found more promising results. Alternative surgical options for treating destructive arthritis include open or arthroscopic synovectomy. While early results are promising, recurrence rates and long-term outcomes are not yet available. Psoriatic arthritis (PsA) is a form of inflammatory arthritis associated with the characteristic dermatologic lesions of psoriasis. The relationship between the skin condition and degenerative arthritis was first made in the 1800s by the French physician, Alibert. Despite this reported clinical association, PsA had been classified as a variant of rheumatoid arthritis (RA) until 1964, when the American Rheumatism Association recognized PsA as a separate entity. Due to this relatively new distinction, there remains a paucity of literature on PsA.