Axial Involvement in a Cohort of Egyptian Patients with Psoriatic Arthritis
Authors: Ali El Sayed Adel Mahmoud , Hamza Sherin Hosny , Khalil Nermeen Samy , Gamal Dalia Mohamed , Mabrouk Fatma Ibrahim 
Published: November 2024

Abstract

Background
Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that occurs in people affected by the autoimmune disease “psoriasis”. It is one of the five types of spondyloarthropathies (SpAs). The disease can vary from asymptomatic to severely debilitating. Joint inflammation can affect either axial or peripheral anatomical regions or both, about 25% to 75% of patients with PsA have axial involvement (axial PsA), with exclusive axial involvement in 5% of patients

Aim of the Work
To assess charcteriastics of axial involvement in patients with psoriatic arthritis (symptoms, spinal mobility, disease activity, radiographic features, associated risk factors, co morbidities).

Patients and Methods
This is a cohort study which was done on 100 psoriatic arthritis patients diagnosed according to the classification criteria for psoriatic arthritis (CASPAR) criteria. Our PsA studied patients were classified to (PsA patients with axial joint affection and PsA patients without axial joint affection according: clinical criteria (inflammatory back pain and /or stiffness - clinical sacroilitis), radiological criteria (presence of sacroilitis – presence of syndesmophytes). All patients were recruited from rheumatology inpatient departments and outpatient clinics at Ain Shams University Hospitals within the years 2021-2023.

Results
49 % of studied PsA patients had axial joint affection; 13% of studied PsA patients had exclusive axial joint affection, the most common joint affection in patients with axial PSA was unilateral sacroiliitis. Smoking, disease onset of skin psoriasis and psoriatic arthritis, family history of skin psoriasis or psoriatic arthritis, morning stiffness, dactylitis, enthesitis, elevated esr and crp were significantly higher in PsA patients with axial joint affection more than PsA patient without axial joint affection. Also BASADI, DAPSA, BASMI, ASDAS-esr, ASDAS-crp, BASMI, PASRI, HAQ, VAS scores were significantly higher in PsA patients with axial joint affection more than PsA patients without axial joint affection. Significant positive correlation found between PASRI score and BASDAI, DAPSA, BASMI, BASFI, HAQ and VAS scores and also positive correlation between PASRI score and ESR, CRP levels while no statistically significant correlation found between PASRI score and PASI score. Significant positive correlation found between BSADI score and DAPSA, BASMI, BASFI, PASI, PASRI, HAQ and VAS scores and also positive correlation between BSADI score and ESR, CRP levels.

Conclusion
The risk factors of developing axial joint affection were smoking, disease onset of skin psoriasis &gt;9 years, disease duration of PsA&gt;6 years, family history of skin psoriasis or PsA, morning stiffness &gt;20 minutes, enthesitis, dactylitis. Also DAPSA score &gt;42, ASDAS ESR score &gt;3.2, ASDAS CRP score &gt;3, BASDAI score &gt; 4.2, BASMI score &gt; 0.9, BASFI score &gt; 4.4, PASRI score &gt; 0, HAQ score &gt;1, ESR&gt; 38, CRP &gt;23, we can use imaging by MRI for screening and detection of PsA patients with axial joint affection without initial articular rheumatic features and identifying the early signs for preventing irreversible evolution, joint damage.