Is surgery an option for my psoriatic arthritis?
There's little research on the benefits and risks of surgery for psoriatic arthritis. But your doctor may recommend it if you have severe joint damage and pain that interferes with daily life.
Psoriatic arthritis surgery often involves the hand, knee, hip or foot joints. Surgery for arthritis-damaged joints could include:
- Joint arthroscopy, which removes or repairs damaged cartilage or torn soft tissues
- Osteotomy, which readjusts the weight distribution on a joint by either removing or adding sections of bone
- Synovectomy, which removes only the damaged lining of the joints (synovium)
- Fusion (arthrodesis), also known as fusion, which connects two bones together to stabilize the joint
- Joint replacement (joint arthroplasty), also known as total joint arthroplasty, which replaces a damaged joint with an artificial joint
- Joint resurfacing, which replaces a portion of a joint with an artificial implant
Understand the risks and benefits
Surgery might help you feel better if you have disabling pain and poor joint function and mobility. Typical candidates for joint surgery have significant joint damage and more-active inflammation than those who don't have surgery.
However, relief may not be long-lasting. Some people with psoriatic arthritis who receive a joint replacement have excess bone growth over time. Over time, the joint can become painful and lose function.
All surgeries come with some risks. One small study hinted that psoriatic arthritis might increase the risk of post-surgical infection, because bacteria can lurk in skin lesions. However, more research is needed to examine this link. If you're having any type of moderate- or high-risk surgery, your doctor should consider your individual risk factors and co-existing health conditions.
Proper management of psoriatic arthritis from the start can help prevent severe joint damage and may make surgery more successful. This includes:
- Maintaining a healthy weight
- Going to physical therapy
- Taking medications as directed
Treatment with medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), or biologics such as tumor necrosis factor-alpha (TNF-alpha) inhibitors, anti-IL-17A and anti-IL-12/IL-23 also can help ward off joint damage, although it is unclear if medications make surgery any more successful.
If you have severe joint damage that affects your ability to perform daily tasks, talk to your doctor about whether surgery might be an option for you.
Jan. 08, 2019
- Gladman D, et al. Treatment of psoriatic arthritis. https://www.uptodate.com/contents/search. Accessed Dec. 10, 2018.
- Mandl L, et al. Short-term total hip arthroplasty outcomes in patients with psoriatic arthritis or psoriatic skin disease compared to patients with osteoarthritis. Arthritis & Rheumatology. 2016;68:410.
- Understanding your joint procedure options. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/treatments/joint-surgery/types/joint-surgery-procedure-options.php. Accessed Dec. 10, 2018.
- Nystad TW, et al. Incidence and predictive factors for orthopedic surgery in patients with psoriatic arthritis. Journal of Rheumatology. 2018;45:1532.
- Rademaker M, et al. Psoriasis and infection. A clinical practice narrative. The Australasian Journal of Dermatology. In press. Accessed Dec. 18, 2018.
- Chang-Miller A (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. Dec. 21, 2018.