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Isolated axial disease in psoriatic arthritis and ankylosing spondylitis with psoriasis
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  • Published on:
    Correspondence on ‘Isolated axial disease in psoriatic arthritis and ankylosing spondylitis with psoriasis’
    • Qiang Tong, Rheumatologist Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
    • Other Contributors:
      • Hua Zhang, Rheumatologist
      • Sheng-Ming Dai, Rheumatologist

    With great interest, we have read the article by Timothy et al. exclusively examined the prevalence and differences associated with isolated axial PsA (axPsA) and isolated axial AS with psoriasis.1 To some extent, we agree with the authors that isolated axPsA and isolated axial AS with psoriasis may be two distinct clinical phenotypes. However, we would like to raise a few important issues that need to be addressed.
    First, the definition of patients with axPsA needs to be discussed. Patients with PsA may have only isolated syndesmophytes without sacroiliitis, one study showed that up to a third of all patients with axPsA have spondylitis without sacroiliitis. 2 In this study, patients with axPsA were identified only by the presence of sacroiliitis on radiographs, which was defined as the presence of sacroiliitis ( grade 2 bilateral or  grade 3 unilateral) on sacroiliac joint radiographs, according to the 1984 AS modified New York criteria. However, some patients with axPsA could present with spondylitis alone but without sacroiliitis, who were not included in the study. Therefore, the overall spectrum of axPsA in this study may be underestimated.
    Second, AS patients with psoriasis must be defined with caution. In terms of clinical features, axPsA differs from AS in several ways, most notably in the radiographic patterns of the disease. axPsA shows radiographic features such as asymmetric sacroiliitis, nonmarginal (which includes “chunky” and “comma”), asymmet...

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    Conflict of Interest:
    None declared.