Axial involvement in psoriatic arthritis

Abstract

    Psoriatic arthritis (PsA) is an inflammatory arthritis that is associated with psoriasis. The cardinal manifestations of PsA include peripheral arthritis, dactylitis, tenosynovitis, nail involvement, and spondylitis. The reported prevalence of spondylitis among patients with PsA ranges from 25% to 55%. The vast difference may be the result of the definition of spondylitis or disease duration. Nevertheless, the prevalence will be at least 25% of patients with PsA. A lower frequency of neck pain and back pain, and less marked limitation of spinal joint movements were noted among patients with PsA compared with patients with ankylosing spondylitis (AS). By contrast, peripheral joint involvement is more common in patients with PsA than in patients with AS. The radiological changes of the spine and sacroiliac joints are more severe in patients with AS than in those with PsA. However, disease activity, functional ability, and quality of life were comparable between patients with AS and those with PsA. It is important to note that patients with asymptomatic spondylitis exist. Treatment with nonsteroidal anti-inflammatory drugs is the recommended first-line therapy in patients with psoriatic spondylitis. However, for those patients whose response is insufficient to control disease activity, tumor necrosis factor inhibitors are recommended.