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Multicenter Study
. 2025 Aug 1;64(8):4539-4545.
doi: 10.1093/rheumatology/keaf137.

Identification and characteristics of patients with axial psoriatic arthritis: clinical, phenotypic and imaging associations

Konstantinos D Vassilakis  1 , Charalampos Papagoras  2 , Sousana Gazi  3 , Evangelia Mole  3 , Michael Krikelis  3 , Paraskevi V Voulgari  4 , Evripidis Kaltsonoudis  4 , Nikolaos Koletsos  4 , Pelagia Katsimpri  5 , Dimitrios Boumpas  5 , Dimitrios Katsifis-Nezis  5 , Nikolaos Kougkas  6 , Maria Boutel  6 , Theodoros Dimitroulas  6 , Petros P Sfikakis  1 , Maria G Tektonidou  1 , Artemis Galani  1 , Nikolaos Michalakeas  1 , Dimitrios P Bogdanos  7 , Theodora Simopoulou  7 , Christos Koutsianas  8 , Evgenia Mavrea  8 , Gkikas Katsifis  9 , Konstantinos Kottas  9 , Maria Konsta  10 , Evangelia Kataxaki  11 , Eleni Kalavri  12 , Kalliopi Klavdianou  12 , Charalampos Sfontouris  13 , Dimitrios Daoussis  14 , George Iliopoulos  14 , Ilias Bournazos  15 , Dimitrios Karokis  15 , Constantinos Georganas  15 , Dimos Patrikos  15 , Dimitrios Vassilopoulos  8 , George E Fragoulis  1   16
Affiliations
Multicenter Study

Identification and characteristics of patients with axial psoriatic arthritis: clinical, phenotypic and imaging associations

Konstantinos D Vassilakis et al. Rheumatology (Oxford). .

Abstract

Objective: To present the clinical and imaging characteristics of patients with axial psoriatic arthritis (PsA) and to identify possible subtypes.

Methods: Data were retrieved from the Greek-multicentre PsA study. Axial PsA (axPsA) was defined as PsA (CASPAR criteria) accompanied by inflammatory back pain (present or ever) and positive imaging findings of the sacroiliac joints and/or spine (MRI: active inflammation of sacroiliac joints and/or spine; X-rays: 1984 New York criteria for radiographic sacroiliitis and/or presence of syndesmophytes in the spine). Demographic and clinical characteristics were compared between axPsA and non-axPsA subsets. Two additional analyses were conducted: (i) isolated sacroiliac joint involvement (sacroiliac axPsA) vs isolated involvement of the rest of the spine (spinal axPsA); (ii) non-radiographic axPsA (nr-axPsA, positive MRI findings only) vs radiographic axPsA (r-axPsA, positive X-ray findings).

Results: Among 922 patients with PsA, 238 (25.8%) had axPsA. Patients with axPsA had less frequently peripheral arthritis at diagnosis, whereas they had increased rates of HLA-B27 positivity, enthesitis ever and inflammatory bowel disease. Among patients with axPsA, 42% (n = 101) had isolated sacroiliac axPsA and 32% (n = 75) had isolated spinal axPsA. Sacroiliac axPsA was associated with younger age (OR: 0.97, 95% CI: 0.94-0.99) and enthesitis at diagnosis (OR: 3.37, 95% CI: 1.66-6.82). A total of 35% of patients with axPsA had nr-axPsA and were more commonly females (OR: 2.59, 95% CI: 1.39-4.82) and younger (OR: 0.96, 95% CI: 0.94-0.99) compared with those with r-axPsA.

Conclusion: Approximately one-quarter of patients with PsA exhibit axial involvement, and among them, ∼30% have isolated spinal axPsA and nr-axPsA, respectively.

Keywords: MRI; PsA; axial involvement; non-radiographic; psoriatic arthritis; sacroiliac joints; spine.

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Comment in

  • Unlocking the power of real-world data.
    Nikiphorou E. Nikiphorou E. Rheumatology (Oxford). 2025 Aug 1;64(8):4455-4456. doi: 10.1093/rheumatology/keaf253. Rheumatology (Oxford). 2025. PMID: 40478567 No abstract available.

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