Abstract
The axial element of psoriatic arthritis has suffered from a lack of validated outcome measures. Therefore, clinical trials demonstrating efficacy with newer therapies—such as biologic disease-modifying drugs, which for the first time have shown evidence of reduction in radiologic damage in peripheral arthritis—have focused on peripheral arthritis and rash, ignoring other outcomes. This article discusses recent advances in assessment measures and therapy recommendations borrowed from the ankylosing spondylitis literature due to the continuing absence of adequate trials examining axial involvement in the psoriatic arthritis population.
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References and Recommended Reading
Resnick D, Niwayama G: Psoriatic arthritis. In Bone and Joint Imaging. Edited by Resnick D. Philadelphia: WB Saunders; 1989:320–328.
Helliwell PS, Hickling P, Wright V: Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, and reactive arthritis? Ann Rheum Dis 1998, 57:135–140.
Gladman DD, Brubacher B, Buskila D, et al.: Differences in the expression of spondyloarthropathy: a comparison between ankylosing spondylitis and psoriatic arthritis. Clin Invest Med 1993, 16:1–7.
Salvarani C, Macchioni P, Cremonesi T, et al.: The cervical spine in patients with psoriatic arthritis: a clinical, radiological and immunogenetic study. Ann Rheum Dis 1992, 51:73–77.
Laiho K, Kauppi M: The cervical spine in patients with psoriatic arthritis. Ann Rheum Dis 2002, 61:650–652.
Nash P: Therapies for axial disease in psoriatic arthritis. A systematic review. J Rheumatol 2006, 33:1431–1434.
Gladman DD, Inman RD, Cook RJ, et al.: International Spondyloarthritis Interobserver Reliability Exercise—The INSPIRE Study: I. Assessment of spinal measures. J Rheumatol 2007, 34:1733–1739.
Chandran V, O’shea FD, Schentag CT, et al.: Relationship between spinal mobility and radiographic damage in ankylosing spondylitis and psoriatic spondylitis: a comparative analysis. J Rheumatol 2007, 34:2463–2465.
Fernandez-Sueiro JL, Willisch A, Pertega-Diaz S, et al.: Evaluation of ankylosing spondylitis spinal mobility measurements in the assessment of spinal involvement in psoriatic arthritis. Arthritis Rheum 2009, 61:386–392.
Daltroy LH, Larson MG, Roberts NW, Liang MH: A modification of the Health Assessment Questionnaire for the spondyloarthropathies. J Rheumatol 1990, 17:946–950.
Wolfe F, Michaud K, Pincus T: Development and validation of the Health Assessment Questionnaire II: a revised version of the Health Assessment Questionnaire. Arthritis Rheum 2004, 50:3296–3305.
Leung YY, Tam LS, Kun EW, et al.: Comparison of 4 functional indexes in psoriatic arthritis with axial or peripheral disease subgroups using Rasch analyses. J Rheumatol 2008, 35:1613–1621.
Salvarani C, Macchioni P, Cremonesi T, et al.: The cervical spine in patients with psoriatic arthritis: a clinical, radiological and immunogenetic study. Ann Rheum Dis 1992, 51:73–77.
Lubrano E, Marchesoni A, Olivieri I, et al.: Psoriatic arthritis spondylitis radiology index: a modified index for radiologic assessment of axial involvement in psoriatic arthritis. J Rheumatol 2009, 36:1006–1011.
Williamson L, Dockerty JL, Dalbeth N, et al.: Clinical assessment of sacroiliitis and HLA-B27 are poor predictors of sacroiliitis diagnosed by MRI in psoriatic arthritis. Rheumatology (Oxford) 2004, 43:85–88.
Muche B, Bollow M, Francois RJ, et al.: Anatomic structures involved in early- and late-stage sacroiliitis in spondyloarthritis. A detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum 2003, 48:1374–1384.
Braun J, Baraliakos X, Golder W, et al.: Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum 2003, 48:1126–1136.
McQueen F, Lassere M, Østergaard M: Magnetic resonance imaging in psoriatic arthritis: a review of the literature. Arthritis Res Ther 2006, 8:207–214.
McHugh NJ, Balachrishnan C, Jones SM: Progression of peripheral joint disease in psoriatic arthritis: a 5-yr prospective study. Rheumatology 2003, 42:778–783.
Gladman DD, Schentag CT, Tom BD, et al.: Psoriatic Arthritis Screen (ToPAS) questionnaire for psoriatic arthritis: the Toronto Development and initial validation of a screening. Ann Rheum Dis 2009, 68:497–501.
Dagfinrud H, Kvien TK, Hagen KB: Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev 2004, CD002822. doi:10.1002/14651858. CD002822.pub2.
Hidding A, van der Linden S, Gielen X, et al.: Continuation of group physical therapy is necessary in ankylosing spondylitis: results of a randomized controlled trial. Arthritis Care Res 1994, 7:90–96.
Wanders A, Heijde D, Landewé R, et al.: Nonsteroidal anti-inflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum 2005, 52:1756–1765.
van der Heijde D, Baraf HS, Ramos-Remus C, et al.: Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: results of a fifty-two-week, randomized, controlled study. Arthritis Rheum 2005, 52:1205–1215.
Peters ND, Ejstrup L: Intravenous methylprednisolone pulse therapy in ankylosing spondylitis. Scand J Rheumatol 1992, 21:134–138.
Mintz G, Enríquez RD, Mercado U, et al.: Intravenous methylprednisolone pulse therapy in severe ankylosing spondylitis. Arthritis Rheum 1981, 24:734–736.
Clegg DO, Reda DJ, Weisman MH, et al.: Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A Department of Veteran Affairs Cooperative Study. Arthritis Rheum 1996, 39:2004–2012.
Dekker-Saeys BJ, Dijkmans BA, Tytgat GN: Treatment of spondyloarthropathy with 5 aminosalicylic acid (mesalazine): an open trial. J Rheumatol 2000, 27:723–726.
Gonzalez-Lopez L, Garcia-Gonzalez A, Vazquez-Del-Mercado M, et al.: Efficacy of methotrexate in ankylosing spondylitis. A randomized, double blind, placebo controlled trial. J Rheumatol 2004, 31:1568–1574.
Grasedyck K, Schattenkirchner M, Bandilla K: The treatment of ankylosing spondylitis with auranofin (Ridaura). Z Rheumatol 1990, 49:98–99.
Palit J, Hill J, Capell HA, et al.: A multicentre double blind comparison of auranofin, intramuscular gold thiomalate and placebo in patients with psoriatic arthritis. Br J Rheumatol 1990, 29:280–283.
Jones G, Crotty M, Brooks P: Psoriatic arthritis: a quantitative overview of therapeutic options. Psoriatic Arthritis Meta-Analysis Study Group. Br J Rheumatol 1997, 36:95–99.
Wei JC, Chan TW, Lin HS, et al.: Thalidomide for severe refractory ankylosing spondylitis: a 6-month open-label trial. J Rheumatol 2003, 30:2627–2631.
Kaltwasser JP, Nash P, Gladman D, et al.: Efficacy and safety of leflunomide in the treatment of psoriatic arthritis and psoriasis: a multinational, double-blind, randomized, placebo-controlled clinical trial. Arthritis Rheum 2004, 50:1939–1950.
van Denderen JC, van der Paardt M, Nurmohamed MT, et al.: Double-blind, randomised, placebo-controlled study of leflunomide in the treatment of active ankylosing spondylitis. Ann Rheum Dis 2005, 64:1761–1764.
Olivieri I, Salvarani C, Cantini F, et al.: Therapy with cyclosporine in psoriatic arthritis. Semin Arthritis Rheum 1997, 27:36–43.
Fraser AD, van Kuijk AW, Westhovens R, et al.: A randomised, double blind, placebo controlled, multicentre trial of combination therapy with methotrexate plus cyclosporin in patients with active psoriatic arthritis. Ann Rheum Dis 2005, 64:859–864.
Maksymowych WP, Jhangri GS, Fitzgerald AA, et al.: A six-month randomized, controlled, double-blind, doseresponse comparison of intravenous pamidronate (60 mg versus 10 mg) in the treatment of nonsteroidal antiinflammatory drug-refractory ankylosing spondylitis. Arthritis Rheum 2002, 46:766–773.
Tan AL, Marzo-Ortega H, O’Connor P, et al.: Efficacy of anakinra in active ankylosing spondylitis: a clinical and magnetic resonance imaging study. Ann Rheum Dis 2004, 63:1041–1045.
Mease PJ, Gladman DD, Keystone EC, on behalf of the Alefacept in Psoriatic Arthritis Study Group: Alefacept in combination with methotrexate for the treatment of psoriatic arthritis results of a randomized, doubleblind, placebo-controlled study. Arthritis Rheum 2006, 54:1638–1645.
Mease PJ, Goffe BS, Metz J, et al.: Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial. Lancet 2000, 356:385–390.
Mease PJ, Kivitz AJ, Burch FX, et al.: Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression. Arthritis Rheum 2004, 50:2264–2272.
Antoni CE, Kavanaugh A, Kirkham B, et al.: Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT). Arthritis Rheum 2005, 52:1227–1236.
Mease PJ, Gladman DD, Ritchlin CT, et al.: Adalimumab for the treatment of psoriasis with moderately to severely active psoriatic arthritis. Arthritis Rheum 2005, 52:3279–3289.
Kavanaugh A, McInnes I, Mease P, et al.: Golimumab, a new human tumor necrosis factor alpha antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis twenty-four-week efficacy and safety results of a randomized, placebo-controlled study. Arthritis Rheum 2009, 60:976–986.
Conti F, Ceccarelli F, Marocchi E, et al.: Switching tumour necrosis factor-a antagonists in patients with ankylosing spondylitis and psoriatic arthritis: an observational study over a 5-year period. Ann Rheum Dis 2007, 66:1393–1397.
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Nash, P. Assessment and treatment of psoriatic spondylitis. Curr Rheumatol Rep 11, 278–283 (2009). https://doi.org/10.1007/s11926-009-0039-8
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DOI: https://doi.org/10.1007/s11926-009-0039-8