Abstract

Patients with rheumatic diseases, such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus, have increased risk of receiving total knee replacement surgery or total hip replacement surgery. We speculated that psoriasis could also attack the joints of the knees and hips, leading to an increased risk of receiving total knee replacement surgery or total hip replacement surgery. The aim of this study was to investigate the risk of total knee replacement or total hip replacement surgery in patients with psoriasis using a nationwide, population-based health claims database in Taiwan. Using the Taiwan's National Health Insurance Research Database, we identified 10,819 patients with psoriasis between 2000 and 2012. A comparison cohort consisting of five patients without psoriasis for each patient with psoriasis was assembled, based on frequency matching for sex, 10-year age interval, and index year. Both groups were followed until a diagnosis of the study outcomes (total knee replacement or total hip replacement surgery) or the end of the follow-up period. Incidence rate ratios (IRRs) for the outcome variables were calculated using multiple Poisson regression models. Female patients with psoriasis exhibited a significantly higher incidence of receiving total knee replacement surgery [adjusted IRR = 1.44, p = 0.014)]. Analyses stratified by age groups showed that the risk of receiving total knee replacement surgery was significantly higher older (adjusted IRR = 1.31, p = 0.047) patients with psoriasis. There were no significant differences in the risk of receiving total hip replacement surgery in patients with psoriasis compared with controls, either with or without stratification by sex or age groups. In conclusion, patients with psoriasis were associated with an increased risk of receiving total knee. Clinicians should be vigilant in assessing the presence of arthritis in these patients, and initiate strategies to delay or prevent the need for joint replacement.

Highlights

  • Psoriasis is a common, chronic, non-communicable, inflammatory skin disease characterized by erythematous, scaly patches, or plaques on the skin [1]

  • Our previous studies have shown that patients with rheumatic diseases, such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus, have increased risk of receiving total knee replacement (TKR) surgery or total hip replacement (THR) surgery [5,6,7]

  • In analyses stratified by the three age groups, only patients with psoriasis showed an increased incidence in TKR in the 60–80 year group

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Summary

Introduction

Chronic, non-communicable, inflammatory skin disease characterized by erythematous, scaly patches, or plaques on the skin [1]. Up to one-third of patients with psoriasis could develop psoriatic arthritis, which is a chronic and potentially severe condition. Our previous studies have shown that patients with rheumatic diseases, such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus, have increased risk of receiving total knee replacement (TKR) surgery or total hip replacement (THR) surgery [5,6,7]. We speculated that psoriasis could attack the joints of the knees and hips resulting in their destruction, which lead to an increased risk of receiving TKR and THR. The aim of this study was to investigate the incidence of THR and TKR in patients with psoriasis using a nationwide, population-based health claims database in Taiwan

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