Psoriatic spondylitis

Abstract

A 43-year-old man presented to the clinic with neck pain and stiffness. He denied any back or radicular pain. He had a long history of psoriasis and suffered multiple peripheral joint pain and stiffness that included the elbow, knee, and distal interphalangeal joints. Spondyloarthritis can be a manifestation of psoriatic arthritis but is rarely present without peripheral joint involvement. Cervical spine imaging displayed cervical apophysial joint ankylosis, the most common spine pathology found in psoriatic arthritis, without ligamentous calcification (Fig. 1, Fig. 2, Fig. 3). Imaging of the lumbar spine did not reveal any of the typical changes of ankylosing spondylitis. The localization of changes to the cervical spine and lack of ligamentous calcification helps to differentiate between psoriatic arthritis and ankylosing spondylitis [ 1 Bobek D. Babić-Naglić D. Potocki K. et al. The cervical spine involvement in patients with psoriatic arthritis. Reumatizam. 2007; 54: 12-15 PubMed Google Scholar , 2 Helliwell P.S. Taylor W.J. Classification and diagnostic criteria for psoriatic arthritis. Ann Rheum Dis. 2005; 64: 3-8 PubMed Google Scholar , 3 Gladman D. Psoriatic arthritis. Baillieres Clin Rheumatol. 1995; 9: 319-329 Abstract Full Text PDF PubMed Scopus (62) Google Scholar ]. Fig. 2CT midsagittal and parasagittal images showed complete ankylosing of the subaxial facet joints sparing the anterior and posterior longitudinal ligaments. CT, computed tomography. View Large Image Figure Viewer Download Hi-res image Fig. 3CT scan axial image of the axial spine showed complete ankylosing of the occiput–C2 joints. CT, computed tomography. View Large Image Figure Viewer Download Hi-res image