Axial Psoriatic Arthritis

Michelena, Xabier; Poddubnyy, Denis; Marzo‐Ortega, Helena

doi:10.1016/j.rdc.2020.01.009

Cited by 25 publications

(13 citation statements)

References 72 publications

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“…Interestingly, HLA-B0801-positive axial PsA patients have asymmetrical and/or unilateral sacroiliac joints, which are typical of PsA, whereas HLA-B27 was associated with bilateral sacroiliitis, corroborating the possible distinct clinical phenotypes of axial PsA and radiographic axSpA. 12,24 Further HLA associations and polymorphisms in the interleukin 23 (IL-23) receptor provide further evidence that AS and axPsA might have a different genetic background and are referenced by Michelena et al 16…”

Section: Geneticsmentioning

confidence: 73%

Psoriatic Spondylitis: A Disease Manifestation in Debate

Zeidler¹

2022

J Clin Rheumatol

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With the advent of classification criteria for psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), patients with axial manifestations associated with psoriasis, initially described in the l950s as a specific entity termed psoriatic spondylitis (PS), are now categorized within PsA, ankylosing spondylitis (AS), and axSpA. Thus, different terms are used to describe axial disease in patients with PsA including PS, axial psoriatic arthritis (axPsA), and psoriatic spondyloarthritis. Patients with PS may present with inflammatory and/or mechanical back pain, but also may display axial disease on imaging despite not complaining of back pain. Cervical spondylitis has been reported in 35% to 75% of patients with PsA. Axial disease is silent in 20% and 25% of patients with axial PsA and PsA, respectively. The majority of axPsA patients have peripheral arthritis alongside the axial involvement, whereas only 2% to 5% of PsA patients have solely axial arthritis with no peripheral arthritis.A debate is currently underway as to whether inflammatory axial disease and psoriasis represent axSpA with psoriasis or a subset of PsA named axPsA. Studies have recognized that axial disease in PsA patients seems to be different demographically, genetically, clinically, and radiographically when compared with AS with or without psoriasis. This narrative review summarizes current knowledge regarding axial involvement of PsA in terms of history, terminology, classification, epidemiology, clinical presentation, imaging, diagnosis, and treatment, with the aim of providing advice for management of PS in clinical evidence-based practice. Data-driven studies are needed to develop clear, nonoverlapping classification criteria for spinal involvement in PsA.

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Section: Geneticsmentioning

confidence: 73%

Psoriatic Spondylitis: A Disease Manifestation in Debate

Zeidler¹

2022

J Clin Rheumatol

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“…IBP is the most typical symptom associated with axial disease, as well as AS [27], and is reported by 15-19% of the PsA patients [28][29][30]. In a recent study, Yap et al, evaluated the performance of various IBP criteria (such as Calin, Berlin and ASAS criteria) in the detection of axial PsA, reporting a low sensitivity and a specificity between 73 and 82% of the 3 criteria in a cohort of patients presenting axial disease on radiographic or MRI imaging [30,31]. Stiffness and cervical pain are also common symptoms in PsA; in fact, in a cohort of established PsA, these symptoms were reported in 24% of the patients, and 41% presented radiographic involvement in the cervical spine, leaving 17% of patients with radiographic disease but no symptoms [15].…”

Section: Symptoms Changes and Outcome Measurementioning

confidence: 99%

Axial Psoriatic Disease: Clinical and Imaging Assessment of an Underdiagnosed Condition

Giovannini

Zabotti

Cicciò

et al. 2021

JCM

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The frequent involvement of the spine and sacroiliac joint has justified the classification of psoriatic arthritis (PsA) in the Spondyloarthritis group. Even if different classification criteria have been developed for PsA and Spondyloarthritis over the years, a well-defined distinction is still difficult. Although the majority of PsA patients present peripheral involvement, the axial involvement needs to be taken into account when considering disease management. Depending on the definition used, the prevalence of axial disease may vary from 25 to 70% in patients affected by PsA. To date, no consensus definition has been reached in the literature and the definition of axial involvement in PsA has varied from isolated sacroiliitis to criteria used in ankylosing spondylitis. This article reviews the unmet needs in the clinical and radiological assessment of axial PsA, reporting the various interpretations of axial involvement, which have changed over the years. Focusing on both imaging and clinical standpoints, we reported the prevalence of clinical and radiologic features, describing the characteristics of axial disease detectable by X-rays, magnetic resonance imaging, and PET-CT, and also describing the axial symptoms and outcome measures in patients affected by axial disease.

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Section: Recognising Psoriatic Arthritismentioning

confidence: 99%

“…Axial involvement in psoriatic arthritis is a well-recognized manifestation with a prevalence between 12.5% and 78% [41]. Inflammatory spondylitis has been reported in a single study to occur in 78% of patients with PsA, although this is typically an imaging diagnosis and is often asymptomatic [41]. Back pain persisting for more than three months, accompanied by morning stiffness for more than half an hour and that is relieved by exercise, is heavily suggestive and should prompt further assessment.…”

Section: Recognising Psoriatic Arthritismentioning

confidence: 99%

“…What begins as oligoarthritis (four or fewer joints) may convert to polyarticular disease over years, and with treatment may revert back to oligoarthritis. Axial involvement may occur at the onset, develop later in the disease course, or be absent entirely [41]. This explains the difficulty in establishing diagnostic criteria.…”

Section: Patterns Of Joint Involvementmentioning

confidence: 99%

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Defining Pre-Clinical Psoriatic Arthritis in an Integrated Dermato-Rheumatology Environment

Savage

Tinazzi

Zabotti

et al. 2020

JCM

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In excess of three quarters of patients with psoriatic arthritis (PsA) have preceding psoriasis (PsO), which offers a clinical biomarker for the recognition of early PsA. Numerous surveys have shown a remarkably high frequency of clinically occult musculoskeletal symptoms in psoriasis patients. Imaging studies, particularly ultrasound, show a high prevalence of subclinical enthesitis and other inflammatory changes in psoriasis subjects. Since a serum biomarker, such as the case of anti-citrullinated protein antibodies (ACPA) in rheumatoid arthritis, neither exists nor seems biologically plausible at this point, this article explores how integration of rheumatological and dermatological assessment can be facilitated for the early recognition of potential PsA. Given that scalp disease is a PsA predictor, but may be managed in the community, then a particular need to access this group is needed. An integrated approach between rheumatology and dermatology can involve joint clinics, parallel clinics with discussion of relevant cases or virtual contact between specialties. Early therapy evaluation and integrated strategies have considerable implications for minimizing suffering and joint damage in PsA.

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Axial Psoriatic Arthritis

Cited by 25 publications

References 72 publications

Psoriatic Spondylitis: A Disease Manifestation in Debate

Psoriatic Spondylitis: A Disease Manifestation in Debate

Axial Psoriatic Disease: Clinical and Imaging Assessment of an Underdiagnosed Condition

Defining Pre-Clinical Psoriatic Arthritis in an Integrated Dermato-Rheumatology Environment

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