Psoriatic spondyloarthropathy: a long term prospective study.

Abstract

SUMMARY Fifty two patients with psoriatic spondyloarthropathy were monitored prospectively over a mean of 57 months (range 30-107). A comprehensive protocol was used to assess clinical and radiological features of disease activity and severity. Serial radiographs showed a significant increase in the number of patients with syndesmophyte formation and sacroiliitis. In contrast, there was no significant increase in the number of patients with inflammatory neck pain or stiffness, back pain or stiffness, cervical spine limitation, or sacroiliac tenderness. Similarly, there were no significant changes in any of the direct or indirect measurements of thoracolumbar spine mobility. The presence of HLA-B27 did not appear to influence disease progression. These results suggest that although patients with psoriatic spondyloarthropathy have radiological progression of their disease, this remains clinically silent and does not compromise spinal mobility.

Enthesitis in Psoriatic Disease

“…For example, synovial joint inflammation can cause capsule distension with pain and swelling, making clinical differentiation from enthesitis problematic [23]. Also, enthesitis like synovitis can be asymptomatic, as evidenced by imaging studies demonstrating enthesopathic changes in the absence of symptoms [27,28,29,30]. It may even be difficult to anatomically locate the enthesis if it is deep within the surrounding tissue and contiguous with synovium [15].…”

Reliability of Radiographic Scoring Methods in Axial Psoriatic Arthritis

“…Due to differences in the criteria used for defining AxPsA, there is wide variability (25-70%) in the reported prevalence of axial involvement in PsA (2). AxPsA can affect the sacroiliac (SI) joints, as well as the lumbar, thoracic, and cervical spine (3,4). A number of the radiographic features of AxPsA are similar to those found in ankylosing spondylitis (AS), although patients with AS generally have more severe radiographic damage compared to AxPsA (5).…”

SPECIFIC FEATURES OF AXIAL SKELETON INVOLVEMENT IN EARLY PSORIATIC ARTHRITIS (The REMARCA TRIAL)

“…К ним можно отнести отсутствие преобладания лиц муж-ского пола, более медленное прогрессирование СИ, ред-кое развитие анкилоза КПС, формирование грубых пара-вертебральных оссификатов между телами позвонков с различной степенью выраженности, большая сохран-ность подвижности позвоночника, относительно щадя-щее поражение апофизарных (дугоотростчатых) суста-вов, частое вовлечение шейного отдела позвоночника и меньшая частота HLA-B27 [9][10][11]. Однако, как показы-вают исследования, по функциональным возможностям, индексам активности спондилита, а также по уровню ка-чества жизни пациенты с аксПсА сопоставимы с больны-ми АС [12].…”