对已确诊的银屑病性关节炎的早期队列研究显示,20% 的患者患上进展性和致残性关节炎。这些观察结论在对早期疾病施行生物疗法和更积极疗法前得出。当前治疗试验已证实,提供的药剂可降低银屑病性关节炎的短期疾病活动。至于早期和演进式积极治疗能否改变该病的自然病程,目前仍有待确定。
关节成形术
高达 7% 的银屑病性关节炎患者可能需要关节手术。最常见的手术是髋关节成形术。髋部受累与银屑病脊柱炎有关,并往往是双侧受累。关节恶化可能会快速发展,导致在症状发作 5 年内实施关节成形术。[37]Zangger P, Gladman DD, Bogoch ER. Musculoskeletal surgery in psoriatic arthritis. J Rheumatol. 1998;25:725-729.http://www.ncbi.nlm.nih.gov/pubmed/9558176?tool=bestpractice.com[38]Michet CJ, Mason TG, Mazlumzadeh M. Hip joint disease in psoriatic arthritis: risk factors and natural history. Ann Rheum Dis. 2005;64:1068-1070.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1755556/pdf/v064p01068.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/15958761?tool=bestpractice.com
死亡率
对专科临床人群的初始观察发现与银屑病性关节炎的预期寿命减少。[40]Ali Y, Tom BD, Schentag CT, et al. Improved survival in psoriatic arthritis with calendar time. Arthritis Rheum. 2007;56:2708-2014.http://onlinelibrary.wiley.com/doi/10.1002/art.22800/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17665458?tool=bestpractice.com在同一诊所的队列随访显示,生存情况随时间推移而得以改善,这可能与较早确认疾病以及疗法经改善后降低了慢性炎症的整体负担有关。在病情较轻的银屑病性关节炎社区队列中,未观察到死亡率上升。[5]Wilson FC, Icen M, Crowson CS, et al. Time trends in epidemiology and characteristics of psoriatic arthritis over 3 decades: a population-based study. J Rheumatol. 2009;36:361-367.http://www.ncbi.nlm.nih.gov/pubmed/19208565?tool=bestpractice.com[40]Ali Y, Tom BD, Schentag CT, et al. Improved survival in psoriatic arthritis with calendar time. Arthritis Rheum. 2007;56:2708-2014.http://onlinelibrary.wiley.com/doi/10.1002/art.22800/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17665458?tool=bestpractice.com