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What Types of Surgery Can Help with Psoriatic Arthritis?

Managing PsA

November 30, 2023

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Photography by Santi Nuñez/Stocksy United

Photography by Santi Nuñez/Stocksy United

by Stacey McLachlan

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Medically Reviewed by:

Daniel Wiznia, MD

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•••••

by Stacey McLachlan

•••••

Medically Reviewed by:

Daniel Wiznia, MD

•••••

•••••

If you’re thinking about getting surgery for PsA, here are important benefits and risks to consider.

There comes a point in almost everyone’s psoriatic arthritis (PsA) journey where enough just feels like enough. The pain has escalated, and the inflammation is just unbearable.

It’s enough to make you wonder if surgery could offer some relief.

During a flare-up, the idea of surgery for PsA might seem like a magic bullet, but the truth is that surgical procedures can come with their own set of challenges.

Let’s delve into the symptoms that may signal the need for surgery and the important factors to consider. We’ll also explore the types of surgical interventions available for psoriatic arthritis and look into what life holds postsurgery … before you commit to taking the plunge.

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Symptoms of psoriatic arthritis and when to consider surgery

If you’re living with psoriatic arthritis, you know that PsA manifests in joint pain, stiffness, and swelling. You might even experience psoriasis skin lesions.

This is all par for the course. But if your symptoms are intensifying to the point that they’re impeding your daily activities and diminishing your quality of life, it may be time to consider surgery as a treatment option.

If you’re experiencing persistent joint pain, limited range of motion, and resistance to conventional treatments, talk with your healthcare team about the surgical options available to you.

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What to consider when making your decision

Making the decision to undergo surgery for psoriatic arthritis isn’t an easy one. You’ve got to weigh the potential benefits against the risks, explore alternative treatments, assess insurance coverage, and find a qualified surgeon.

It’s also important to understand the long-term impact of surgery and discuss these factors with your healthcare team.

Benefits and risks

Surgical interventions for PsA can provide relief from pain and improve joint function. But, like any medical procedure, there are possible risks to surgery.

Risks include:

  • infection
  • blood clots
  • adverse reactions to anesthesia
  • an increase in pain
  • stiffness
  • decreased range of motion

You’ll want to thoroughly discuss these potential outcomes with your healthcare team before making any decision about surgery for your PsA.

Other potential treatments

Surgery is just one option for managing PsA. Before opting for surgery, you may want to explore nonsurgical treatments:

  • Medication: Over-the-counter anti-inflammatory drugs may offer some relief for milder cases, while prescription anti-inflammatories may be required for more severe cases. Disease-modifying antirheumatic drugs (DMARDs) can be prescribed as well.
  • Physical therapy: Physical therapy may include guided exercises, strength training, or stretching. Overall, increasing your range of motion is the goal.
  • Lifestyle changes: Reducing stress, participating in low impact physical activities like walking or swimming, getting enough rest, and avoiding inflammatory foods can all help reduce symptoms.

These alternatives may offer you relief without the associated risks of surgery.

Insurance coverage

It may be a chore, but understanding your insurance coverage for surgical procedures is vital.

Before committing to any treatment, verify your policy’s terms, including coverage for specific surgeries and related expenses, to avoid an unexpected financial burden.

Finding the right doctor

Just like finding the right dermatologist or rheumatologist, teaming up with a skilled and experienced surgeon for your PsA surgery is crucial for successful outcomes. Seek out specialists familiar with PsA and its nuances — this is your best bet for a comprehensive (and personalized) approach to care.

Surgery for psoriatic arthritis

There are several surgical options available for treating psoriatic arthritis. Each is tailored to address specific symptoms and joint issues.

Talk with your doctor about the best options for your specific symptoms.

Arthrodesis

This procedure involves fusing joints to reduce pain and improve stability. Arthrodesis is commonly performed on smaller joints.

For this surgery, you’ll be given general anesthesia. Your surgeon will then implant hardware (pins, plates, or rods) to keep your joint from moving. While you’re healing, bones on either side of the problem joint will usually grow into one continuous bone.

The downside of this procedure is that it limits joint movement. The benefit? Arthrodesis can provide lasting relief for many who live with psoriatic arthritis.

Synovectomy

In a synovectomy, the inflamed synovial lining of the joint is removed to alleviate pain and reduce inflammation. (It’s a procedure that may be used to treat rheumatoid arthritis, too.)

This can be particularly beneficial for anyone with persistent swelling who doesn’t respond well to anti-inflammatory medication. It’s a procedure that can relieve pain and improve function … though perhaps only temporarily if the synovium grows back.

In some cases, synovectomy may lead to instability of the joint.

Arthroplasty

Joint replacement surgery, or arthroplasty, is a more extensive intervention involving the replacement of damaged joints (typically your knees) with artificial implants.

This option is often considered for your larger joints if you’re severely affected by PsA. It can help with deformity, increase range of motion, reduce pain, and help make it easier to perform daily activities.

The majority of arthroplasty is performed under spinal anesthesia. Your surgeon will take out damaged bone and cartilage before installing new implants for your joint. Most people are able to leave the hospital the same day or the next morning — normal activities should resume over 3–6 months.

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Recovery and life after surgery

Recovery from psoriatic arthritis surgery will vary from person to person, depending on the type and extent of the procedure. Physical therapy is typically recommended to restore joint function and mobility.

No matter the treatment, your initial recovery period from PsA surgery will likely involve some discomfort. (Sorry!) But the good news is that many people experience significant improvement in their quality of life postsurgery — just make sure to listen to your physical therapist!

Potential complications

Complications associated with PsA surgeries are mostly the same as with any other surgical procedure.

The most common complication is infection. Other potential (but rare) complications of joint surgery may include blood clots, issues with anesthesia, malfunctioning of implants, or nerve injury.

If you get a synovectomy, it’s possible to experience tissue damage, numbness or tingling, or drainage from the surgical area.

For any surgery, if you are taking DMARDs, it’s important to consult with your rheumatologist or orthopedic surgeon to time the dosing of the medication with the surgery. This can help reduce the risk of being immunocompromised during or after the surgery.

It’s crucial to be aware of these potential complications before your surgery. With this knowledge in hand, you can work closely with your healthcare team to minimize risks.

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Takeaway

Surgery for PsA is a viable option for you if your symptoms are not adequately managed by medication or other nonsurgical interventions.

As with any surgery, psoriatic arthritis procedures should be approached with careful consideration. Weigh the benefits against the risks and communicate actively with your healthcare team to find what’s best for your unique case.

Medically reviewed on November 30, 2023

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About the author

Stacey McLachlan

Stacey McLachlan is a writer, editor from Vancouver, B.C. specializing in design, food and travel writing. She earned her BA in Communications from Simon Fraser University and is editor-at-large for Western Living and Vancouver magazines. Stacey is a regular contributor to Dwell and has been published by the Globe and Mail, Montecristo, and Healthline, among other outlets. Find her on her website.

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