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Current Rheumatology Reviews

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ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

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Research Article

Axial Involvement in Psoriatic Arthritis: A Cross-sectional Clinical and Radiologic Studies

Author(s): Noha A. Elsawy, Shaimaa E. Farahat, Mohamed M. El Shafei and Rehab Elnemr*

Volume 20, Issue 2, 2024

Published on: 20 September, 2023

Page: [165 - 175] Pages: 11

DOI: 10.2174/1573397119666230911111023

Price: $65

Abstract

Objective: This study aimed to investigate spinal involvement in psoriatic arthritis (PsA) patients using clinical and radiographic methods.

Methods: A cross-sectional clinical study was conducted on 50 PsA patients diagnosed according to the CASPAR criteria. Clinical examinations and functional assessments were performed. A radiographic assessment of the spine was performed.

Results: Out of 50 PsA patients (mean age of 45.50 ± 9.90 years), (males and females constituted 27 (54.0%) and 23 (46.0%) respectively), 76% had radiological axial involvement; (26%) with inflammatory axial pain and (50%) without inflammatory axial pain (subclinical). Three axial radiographic patterns were detected including spondylitis without sacroiliitis (15.78%), spondylitis with sacroiliitis (78.94%), and sacroiliitis without spondylitis (5.26%).

In axial PsA patients, males were more affected than females (χ2=11.679, p = 0.003), with older age (H = 15.817, p < 0.001) and higher body mass index (BMI) (F = 5.145, p = 0.010), increased psoriasis duration (H = 9.826, p = 0.007) and severity (Η=25.171, p < 0.001), and more spinal movement limitations than PsA patients without axial involvement (F = 26.568, p < 0.001).

Cervical involvement was higher than lumbar involvement. Axial radiographic severity assessed by the PsA Spondylitis Radiology Index was associated with increased disability as assessed by the Health assessment questionnaire (rs = 0.533, p = 0.001) and decreased quality of life assessed by short form-36 score (rs = -0.321, p = 0.050).

Conclusion: This study shows that a high percentage of PsA patients had axial involvement with a high percentage of them having asymptomatic radiological findings. The cervical spine is more frequently and severely affected than the lumbar spine. Axial PsA occurs in males more than females with characteristic older age and higher BMI, increased psoriasis duration, and more limitation of spinal mobility.

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Graphical Abstract

[1]
Ruiz DG, Azevedo MN, Santos OL. Psoriatic arthritis: a clinical entity distinct from psoriasis? Rev Bras Reumatol 2012; 52(4): 630-8.
[http://dx.doi.org/10.1590/S0482-50042012000400012] [PMID: 22885427]
[2]
Bruce IN. Psoriatic arthritis: clinical features. 2003.
[3]
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H. Classification criteria for psoriatic arthritis: Development of new criteria from a large international study. Arthritis Rheum 2006; 54(8): 2665-73.
[http://dx.doi.org/10.1002/art.21972] [PMID: 16871531]
[4]
Moll JMH, Wright V. Psoriatic arthritis. Semin Arthritis Rheum 1973; 3(1): 55-78.
[http://dx.doi.org/10.1016/0049-0172(73)90035-8] [PMID: 4581554]
[5]
Kane D, Stafford L, Bresnihan B, FitzGerald O. A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Br J Rheumatol 2003; 42(12): 1460-8.
[http://dx.doi.org/10.1093/rheumatology/keg384] [PMID: 14523223]
[6]
Gladman DD. Axial disease in psoriatic arthritis. Curr Rheumatol Rep 2007; 9(6): 455-60.
[http://dx.doi.org/10.1007/s11926-007-0074-2] [PMID: 18177598]
[7]
Queiro R, Tejón P, Alonso S, Alperi M, Ballina J. Erosive discovertebral lesion (Andersson lesion) as the first sign of disease in axial psoriatic arthritis. Scand J Rheumatol 2013; 42(3): 220-5.
[http://dx.doi.org/10.3109/03009742.2012.739637] [PMID: 23311864]
[8]
Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis 2020; 79(6): 700.1-12.
[http://dx.doi.org/10.1136/annrheumdis-2020-217159] [PMID: 32434812]
[9]
Giovannini I, Zabotti A, Cicciò C, et al. Axial psoriatic disease: Clinical and imaging assessment of an underdiagnosed condition. J Clin Med 2021; 10(13): 2845.
[http://dx.doi.org/10.3390/jcm10132845] [PMID: 34199051]
[10]
Jadon DR, Sengupta R, Nightingale A, et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis. Ann Rheum Dis 2017; 76(4): 701-7.
[http://dx.doi.org/10.1136/annrheumdis-2016-209853] [PMID: 27913376]
[11]
Aletaha D, Alasti F, Smolen JS. Disease activity states of the DAPSA, a psoriatic arthritis specific instrument, are valid against functional status and structural progression. Ann Rheum Dis 2017; 76(2): 418-21.
[http://dx.doi.org/10.1136/annrheumdis-2016-209511]
[12]
Wall PD, Melzack R, Katz J. Pain measurement in persons in pain, rating scales. In: Wall PD, Melzack R, Katz J, Eds. Textbook of pain I. (3rd ed..). UK: Longman group UK 1994; pp. 338-9.
[13]
Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68 (Suppl. 2): ii1-ii44.
[http://dx.doi.org/10.1136/ard.2008.104018] [PMID: 19433414]
[14]
Laslett M, Young SB, Aprill CN, McDonald B. Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother 2003; 49(2): 89-97.
[http://dx.doi.org/10.1016/S0004-9514(14)60125-2] [PMID: 12775204]
[15]
Eder L, Chandran V, Shen H, Cook RJ, Gladman DD. Is ASDAS better than BASDAI as a measure of disease activity in axial psoriatic arthritis? Ann Rheum Dis 2010; 69(12): 2160-4.
[http://dx.doi.org/10.1136/ard.2010.129726] [PMID: 20627946]
[16]
Creemers MCW, Franssen MJ, van’t Hof MA, Gribnau FW, van de Putte LB, van Riel PL. Assessment of outcome in ankylosing spondylitis: An extended radiographic scoring system. Ann Rheum Dis 2005; 64(1): 127-9.
[http://dx.doi.org/10.1136/ard.2004.020503] [PMID: 15051621]
[17]
Lubrano E, Marchesoni A, Olivieri I, et al. Psoriatic arthritis spondylitis radiology index: A modified index for radiologic assessment of axial involvement in psoriatic arthritis. J Rheumatol 2009; 36(5): 1006-11.
[http://dx.doi.org/10.3899/jrheum.080491] [PMID: 19332625]
[18]
Chow C, Simpson MJ, Luger TA, Chubb H, Ellis CN. Comparison of three methods for measuring psoriasis severity in clinical studies (Part 1 of 2): change during therapy in Psoriasis Area and Severity Index, Static Physician’s Global Assessment and Lattice System Physician’s Global Assessment. J Eur Acad Dermatol Venereol 2015; 29(7): 1406-14.
[http://dx.doi.org/10.1111/jdv.13132] [PMID: 25917315]
[19]
Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A, et al. Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003; 62(2): 127-32.
[http://dx.doi.org/10.1136/ard.62.2.127] [PMID: 12525381]
[20]
Mease PJ, Antoni CE, Gladman DD, Taylor WJ. Psoriatic arthritis assessment tools in clinical trials. Ann Rheum Dis 2005; 64 (Suppl. 2): ii49-54.
[http://dx.doi.org/10.1136/ard.2004.034165] [PMID: 15708937]
[21]
Chandran V, Bhella S, Schentag C, Gladman DD. Functional assessment of chronic illness therapy-fatigue scale is valid in patients with psoriatic arthritis. Ann Rheum Dis 2007; 66(7): 936-9.
[http://dx.doi.org/10.1136/ard.2006.065763] [PMID: 17324972]
[22]
McKenna SP, Doward LC, Whalley D, Tennant A, Emery P, Veale DJ. Development of the PsAQoL: A quality of life instrument specific to psoriatic arthritis. Ann Rheum Dis 2004; 63(2): 162-9.
[http://dx.doi.org/10.1136/ard.2003.006296] [PMID: 14722205]
[23]
Punzi L, Podswiadek M, Oliviero F, et al. Laboratory findings in psoriatic arthritis. Reumatismo 2007; 59 (Suppl. 1): 52-5.
[http://dx.doi.org/10.4081/reumatismo.2007.1s.52] [PMID: 17828345]
[24]
IBM. SPSS Statistics for Windows, version 2011: 200. Armonk, NY: IBM 2011.
[25]
Battistone MJ, Manaster BJ, Reda DJ, Clegg DO. The prevalence of sacroilitis in psoriatic arthritis: New perspectives from a large, multicenter cohort. A Department of Veterans Affairs Cooperative Study. Skeletal Radiol 1999; 28(4): 196-201.
[http://dx.doi.org/10.1007/s002560050500] [PMID: 10384989]
[26]
Lubrano E, Parsons WJ, Marchesoni A, et al. The definition and measurement of axial psoriatic arthritis. J Rheumatol Suppl 2015; 93(0): 40-2.
[http://dx.doi.org/10.3899/jrheum.150634] [PMID: 26523055]
[27]
Russolillo A, Iervolino S, Peluso R, et al. Obesity and psoriatic arthritis: From pathogenesis to clinical outcome and management. Rheumatology 2013; 52(1): 62-7.
[http://dx.doi.org/10.1093/rheumatology/kes242] [PMID: 22989426]
[28]
Petcharat C, Srinonprasert V, Chiowchanwisawakit P. Association between syndesmophyte and metabolic syndrome in patients with psoriatic arthritis or ankylosing spondylitis: A cross-sectional study. BMC Musculoskelet Disord 2021; 22(1): 367.
[http://dx.doi.org/10.1186/s12891-021-04222-8] [PMID: 33879097]
[29]
Mease PJ, Palmer JB, Liu M, et al. Influence of axial involvement on clinical characteristics of psoriatic arthritis: Analysis from the corrona psoriatic arthritis/spondyloarthritis registry. J Rheumatol 2018; 45(10): 1389-96.
[http://dx.doi.org/10.3899/jrheum.171094] [PMID: 29961691]
[30]
Chandran V. Psoriatic spondylitis or ankylosing spondylitis with psoriasis: Same or different? Curr Opin Rheumatol 2019; 31(4): 329-34.
[http://dx.doi.org/10.1097/BOR.0000000000000609] [PMID: 31135567]
[31]
Paine A, Ritchlin C. Altered bone remodeling in psoriatic disease: New insights and future directions. Calcif Tissue Int 2018; 102(5): 559-74.
[http://dx.doi.org/10.1007/s00223-017-0380-2] [PMID: 29330560]
[32]
Mensah KA, Schwarz EM, Ritchlin CT. Altered bone remodeling in psoriatic arthritis. Curr Rheumatol Rep 2008; 10(4): 311-7.
[http://dx.doi.org/10.1007/s11926-008-0050-5] [PMID: 18662512]
[33]
Jeannou J, Goupille P, Avimadje MA, Zerkak D, Valat JP, Fouquet B. Cervical spine involvement in psoriatic arthritis. Rev Rhum Engl Ed 1999; 66(12): 695-700.
[PMID: 10649603]
[34]
Mease PJ, Garg A, Helliwell PS, Park JJ, Gladman DD. Development of criteria to distinguish inflammatory from noninflammatory arthritis, enthesitis, dactylitis, and spondylitis: A report from the GRAPPA 2013 Annual Meeting. J Rheumatol 2014; 41(6): 1249-51.
[http://dx.doi.org/10.3899/jrheum.140182] [PMID: 24882864]
[35]
Mulder MLM, van Hal TW, Wenink MH, et al. Clinical, laboratory, and genetic markers for the development or presence of psoriatic arthritis in psoriasis patients: A systematic review. Arthritis Res Ther 2021; 23(1): 168.
[http://dx.doi.org/10.1186/s13075-021-02545-4] [PMID: 34127053]
[36]
del Río-Martínez P, Navarro-Compán V, Díaz-Miguel C, Almodóvar R, Mulero J, De Miguel E. Similarities and differences between patients fulfilling axial and peripheral ASAS criteria for spondyloarthritis: Results from the Esperanza Cohort. Semin Arthritis Rheum 2016; 45(4): 400-3.
[http://dx.doi.org/10.1016/j.semarthrit.2015.09.001] [PMID: 26601781]
[37]
de Winter JJ, Paramarta JE, de Jong HM, van de Sande MG, Baeten DL. Peripheral disease contributes significantly to the level of disease activity in axial spondyloarthritis. RMD Open 2019; 5(1): e000802.
[http://dx.doi.org/10.1136/rmdopen-2018-000802] [PMID: 30713720]
[38]
Orbai AM, de Wit M, Mease P, et al. International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis 2017; 76(4): 673-80.
[http://dx.doi.org/10.1136/annrheumdis-2016-210242] [PMID: 27613807]
[39]
Maher T, Yassine ZA, Majdi BH, Nader N. C1-C2 instability in psoriatic arthritis. Pan Afr Med J 2020; 36: 217.
[http://dx.doi.org/10.11604/pamj.2020.36.217.24850] [PMID: 32963683]
[40]
Yap KS, Ye JY, Li S, Gladman DD, Chandran V. Back pain in psoriatic arthritis: Defining prevalence, characteristics and performance of inflammatory back pain criteria in psoriatic arthritis. Ann Rheum Dis 2018; 77(11): 1573-7.
[http://dx.doi.org/10.1136/annrheumdis-2018-213334] [PMID: 30077991]

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