Title:Axial Involvement in Psoriatic Arthritis: A Cross-sectional Clinical and
Radiologic Studies
Volume: 20
Issue: 2
Author(s): Noha A. Elsawy, Shaimaa E. Farahat, Mohamed M. El Shafei and Rehab Elnemr*
Affiliation:
- Department of Physical Medicine Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University,
Alexandria, Egypt
Keywords:
Psoriatic arthritis, inflammatory axial pain, sacroiliitis, cervical spine, spondylitis, lumbar spine.
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.
