Prognosis

Early cohort studies of established psoriatic arthritis (PsA) revealed that at least 20% of patients develop progressive and disabling arthritis.[108]​ These observations were made prior to the advent of biological therapies and more aggressive treatment of early disease. Current therapeutic trials have demonstrated that available agents reduce short-term PsA disease activity. It remains to be determined whether early and progressively aggressive therapy will change the natural history of the disease.

Joint arthroplasty

Up to 30% of patients with PsA may require joint surgery.[109][110]​ The most common operation is hip arthroplasty. Hip involvement is related to psoriatic spondylitis and is frequently bilateral. Joint deterioration may be rapidly progressive, resulting in arthroplasty within 5 years of the onset of symptoms.[109][111]

Mortality

Initial observations from a speciality clinic population found a reduced life expectancy associated with PsA.[112] Follow-up of cohorts in the same clinic has demonstrated improved survival over time, perhaps related to identification of earlier disease and improved therapy reducing the overall burden of chronic inflammation.

Community-based cohort studies of PsA in patients with less severe disease found no increase in mortality.[8][112]​​ However, a further subsequent nationwide registry-based cohort study in Norway reported a slightly increased mortality rate in women with PsA (HR 1.10, 95% CI 1.00 to 1.21); no increased risk of mortality was observed in men with PsA.[113]​ There is also evidence to suggest that young patients with PsA have an age-specific increased risk of mortality.[114]

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