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Review
. 2021 Aug;51(4):880-887.
doi: 10.1016/j.semarthrit.2021.06.006. Epub 2021 Jun 19.

Axial involvement in psoriatic arthritis: An update for rheumatologists

Denis Poddubnyy  1 , Deepak R Jadon  2 , Filip Van den Bosch  3 , Philip J Mease  4 , Dafna D Gladman  5
Affiliations
Free article
Review

Axial involvement in psoriatic arthritis: An update for rheumatologists

Denis Poddubnyy et al. Semin Arthritis Rheum. 2021 Aug.
Free article

Abstract

Psoriatic arthritis (PsA) is a heterogenous, chronic, inflammatory musculoskeletal disease that can lead to peripheral and axial damage and loss of function. Axial involvement occurs in 25% to 70% of patients with PsA, varying greatly depending on its definition, with the key manifestations being sacroiliitis and/or spondylitis. However, there are no agreed-upon classification or diagnostic criteria for axial involvement in PsA and no consensus on treatment paradigms, which complicates management of PsA. There have only been a few studies assessing biologics in patients with PsA with axial involvement, and most treatment plans are based on evidence from patients with axial spondyloarthritis. Rheumatologists therefore face many challenges in the management of axial PsA, including diagnosis, differential diagnosis, and choice of appropriate treatment. In this review, we summarize the clinical presentation, imaging characteristics, differential diagnoses, treatment options, and prognosis of axial PsA, with the aim of increasing rheumatologists' knowledge of this phenotype of PsA and thereby aiding its optimal management.

Keywords: Inflammatory arthritis; Inflammatory back pain; Psoriatic arthritis; Spondyloarthropathies.

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Conflict of interest statement

Declarations of Interest D. Poddubnyy has received research grants from AbbVie, Eli Lilly, MSD, Novartis, and Pfizer and has received consultancy or speaker fees from AbbVie, Biocad, Bristol Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB. D.R. Jadon has received research grants from Pfizer, Eli Lilly, Merck, GSK, Biogen, and Celgene and has received educational grants from Novartis, Eli Lilly, Biogen, Gilead, Pfizer, UCB, AbbVie, Janssen, Amgen, Bristol Myers Squibb, Roche, and Celltrion; his research time was also partially funded by the Cambridge Arthritis Research Endeavour. F. Van den Bosch has received consultancy and/or speaker fees from AbbVie, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Novartis, Pfizer, and UCB. P.J. Mease has received research grants from Celgene, Novartis, AbbVie, Amgen, Bristol Myers Squibb, Gilead, Eli Lilly, Pfizer, Sun Pharma, and UCB; consulting fees from Celgene, Corrona, Novartis, AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Galapagos, Gilead, GSK, Janssen, Eli Lilly, Merck, Pfizer, Sun Pharma, and UCB; and speakers bureau fees from AbbVie, Amgen, Janssen, Novartis, Pfizer, and UCB. D.D. Gladman has received research grants from AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Pfizer, and UCB and consulting fees from AbbVie, Amgen, Bristol Myers Squibb, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB.