Perioperative Management of Patients with Psoriatic Arthritis: Case Report and Literature Review

Abstract

Background: This paper aims to explore the assessment of patients with psoriatic arthritis before undergoing orthopaedic surgery. Perioperative assessment starts with early diagnosis of the patient’s medical condition, overall health, medical co-morbidities, and the assessment of the risk factors associated with the proposed procedures. This allows for assessment and prevention of postoperative management of complications. Role of the management of drugs used for psoriasis such as Disease-Modifying Anti- Rheumatic Drugs (DMARD) and anti-platelets, and corticosteroids is also important. Perioperative assessment enables the discussion of the proposed treatment plans and the factors associated with them in each case among the different specialists involved to facilitate an appropriate early decision-making and better treatment outcomes. This article will review components of perioperative medical evaluation, discusses perioperative management of comorbidities and the management of specific clinical problems related to psoriasis. The article will tackle the management of DMARDs and biologic therapies, glucocorticoids, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation. Case presentation: We report the case of a 32 year old lady on treatment for skin psoriasis and arthritis who presents with bilateral hip pain. Investigations reveal grade 2 avascular necrosis of femoral head on magnetic resonance imaging. She also had dyslipidemia, obesity and osteoporosis that may be the consequence of long term steroid use. We discuss the perioperative management of this patient. Conclusion: Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy. Arthropathy with severe structural damage in these patients may be treated successfully with surgery. There is paucity of data as few large-scale, high quality trials have been conducted. Postoperative infection remains a prominent concern, although debate regarding the true risk of infection is ongoing. Collaboration with dermatologists, rheumatologists and orthopaedic surgeons is essential to the successful surgical treatment of PsA.