Tamara Thomas

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About 20% of adults with axial psoriatic arthritis (PsA) show active or structural spinal changes without changes in the sacroiliac joint, according to a study presented at the annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). 
In the past, Axial PsA has been lumped together with axial spondyloarthritis (axSpA). However, in recent years, several studies have attempted to delineate both conditions. 
Data from previous studies have found genetic, clinical, radiographic, and prognostic differences between axial PsA and axSpA that may affect patients’ response to available treatments. However, there is little or no data on distinguishing imaging and clinical features, as there is a lack of classification criteria for axial PsA.
A study by Ms. Henriette Käding and colleagues at a University in Berlin analyzed axial PsA patients between August 2019 and June 2023 to determine any distinguishing imaging and clinical features. 
The study included 106 patients, of which 55.7% were female. The mean age of the included patients was 44.5 years. Clinical assessments were made for all participants at the start of the study. Blood and stool samples were also obtained, and an MRI of the whole spine and sacroiliac joint (SIJ) was performed.
At the start of the study, approximately 78% of patients had inflammatory back pain, and about 48% tested positive for HLA-B27, a genetic risk factor for both axSpA and axial PsA. Furthermore, they observed that in the baseline MRI scans, about 52% of the patients had inflammatory changes in the sacroiliac joints (SIJ), and 72% showed structural changes. MRI spine scans also showed that about 59% of the patients showed active changes. According to Ms. Käding, active and/or structural changes of the spine without changes in the SIJ appeared in 20% of the patients.
“In individuals with PsA, spinal involvement can occur independently of sacroiliac joint [involvement]. As a result, imaging studies conducted on patients suspected of having axial PsA should encompass not only the sacroiliac joints but also the spine,” Dr. Denis Poddubnyy, one of the study co–authors wrote. “It is important to note, however, that imaging findings such as bony spurs and bone marrow edema might be caused by degeneration or mechanical issues and, therefore, need to be interpreted with caution within the clinical context,” she added.
Looking at the already existing classification criteria, the researchers observed that 92% of the patients met the diagnostic criteria for PSA, 73% met the diagnostic criteria for axSpA, and 66% met both.   
“Axial involvement in PsA might, on the one hand, go unnoticed, but on the other hand, it could also be misdiagnosed in patients with degenerative spinal disease,” Dr. Poddubnyy wrote. “By comprehending the unique characteristics, progression, and treatment responses within the axial domain, rheumatologists can customize interventions and therapies to effectively manage the psoriatic disease,” she added. 
Disclosure: Dr. Poddubnyy and another coauthor, Dr. Proft, disclosed receiving research grants and consultancy payments from Novartis and serving on speaker bureaus for the company.
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Source: <a href="https://www.mdedge.com/rheumatology/article/264933/psoriatic-arthritis/structural-changes-may-separate-axial-psoriatic">MDEdge</a>

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"...imaging studies conducted on patients suspected of having axial PsA should encompass not only the sacroiliac joints but also the spine."