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

Ivan Giovannini,Salvatore De Vita,Matteo Salgarello,Alen Zabotti,Ilaria Tinazzi,Lorenzo Cereser,Carmelo Cicciò

doi:10.3390/jcm10132845

Abstract

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.

Highlights

Psoriatic arthritis (PsA) is a common chronic and potentially debilitating inflammatory arthropathy, affecting 0.4–2% of the general population [1], and from 7 to 42% of psoriasis patients develop arthritis [2]
PsA may begin with several clinical features such as peripheral arthritis, dactylitis, enthesitis, and axial disease [3,4]; dactylitis and enthesitis in particular have a relevant role in the early identification of PsA
The majority of PsA patients present peripheral involvement [7], which has been largely studied over the years, but a widely accepted definition of axial involvement remains problematic

Summary

Introduction

Psoriatic arthritis (PsA) is a common chronic and potentially debilitating inflammatory arthropathy, affecting 0.4–2% of the general population [1], and from 7 to 42% of psoriasis patients develop arthritis [2]. Stiffness and cervical pain are common symptoms in PsA; 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] These data support the idea that clinical symptoms are not accurate predictors of cervical spine involvement, erosive and progressive PsA might be screened for atlanto-axial instability, a potentially serious complication. The high prevalence of radiographic cervical spine involvement was successively reported in 41% by Queiro et al in 2002 In this Spanish cohort, 58.5% of patients complained of cervical pain and stiffness, whereas 41.5% presented radiologic changes without symptoms [15]. PASRI has the advantage over BASRI and mSASSS to detect posterior axial involvement, in assessing the sacroiliac joints and the cervical and lumbar spine, PASRI might extend the radiological assessment of axial PsA to consider the facet joints of the spine

Magnetic Resonance Imaging Changes

Findings

Research Agenda