Background Spondylitis associated with peripheral psoriatic arthritis occurs in 40% to 70% of the patients, depending on whether or not radiographs are taken (1). Careful clinical and radiologic assessment, however, reveals involvement of the axial spine in 20% to 40% of cases, increasing to as many as 51% at long-term follow-up (2). Involvement of the sacroiliac joints can be symmetric or asymmetric. During follow-up,although the radiographic changes in the spine tend to progress,spinal mobility is preserved or improves, and this form of spinal disease carries a better prognosis than pure ankylosing spondylitis.(2) Queiro et al had reported asymptomatic spondilitis in 20% of patients with psoriatic arthritis (PA), and Taylor et al had reported a higher frequency of radiological lesions without symptoms (3,4,5).
Objectives To identify the functional impact of asymtomatic axial involvement in patients with PA
Methods 88 PA patients (59.1%, women, mean age 55.53±11.06 years, mean of PA duration about 12.49±11.61 years) were included. Patients were assessed as followings: demographical, medical history, a clinical assessment for joint disease (activity score like BASDAI, functional score like BASFI, mobility score like BASMI and classical indices) and an radiological assessment for progression (sacroiliac and vertebral according BASRI score).We have considered axial involvement the presence of sacroiliitis and/or vertebral spondylitis.
Results We had noticed asymptomatic axial involvement in 13.63% (12 patients) patients, been 83% of them with sacroiliitis graded 3 and 4. Regarding functionality, BASFI had a mean about 3.77±2.33 (p=0.006) versus 6.29±2.71 in patients with lumbar pain and PA. Mobility is clearly better in patients with asymptomatic sacroiliitis: BASMI score (1±1.41, 3.23±3.01, p=0.008), Schober index (4.33±1.48, 3.35±2.32, p=0.003), chest expansion index (2.54±0.96, 2.40±1.38, p=NS), menton-stern index (2.5±1.5, 3.82±2.09, p=0.043). The activity score BASDAI had differences in groups with or without spinal pain (5.91±2.4, 4.16±1.9, p=0.028). The radiological score BASRI had any significant differences between groups (5.54±3.91, 5.64±3.19, p=NS).
Conclusions Even asymptomatic, axial involvement is present and give them quiet spinal disability and severe radiological progression
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Disclosure of Interest None declared