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Axial Psoriatic Arthritis

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Purpose of Review

To review current understanding of the prevalence, clinical features, outcome measures and recent therapeutic trials in axial psoriatic arthritis (axPsA).

Recent Findings

The prevalence of axPsA is estimated at 40–50%. However, the definition of axPsA remains unclear, therefore these estimates may be inaccurate. Ax PsA appears to be distinct from ankylosing spondylitis in demographic, clinical, genetic and therapeutic features. Because of the lack of widely accepted definition of axPsA it has been difficult to design therapeutic trials for this domain of PsA.


Several studies have demonstrated the uniquness of axPsA. Few recent trials suggest that therapies that work for peripheral arthritis also work for axPsA.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Dr. Gladman’s research is supported by the Krembil Foundation, the Canadian Institutes of Health Research, and the National Psoriasis Foundation.

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Correspondence to Dafna D. Gladman.

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Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest

Dr. Gladman has received trial grants and or consulting fees from AbbVie, Amgen, BMS, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB.

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Key Points

• Ankylosing spondylitis and axial psoriatic arthritis are both part of the spectrum of spondyloarthritis and have overlapping features but also differ in their genetic, clinical, radiographic, and prognostic characteristics.

• HLA-B*27 occurs less frequently in axial psoriatic arthritis than in ankylosing spondylitis but is a genetic risk factor for both diseases.

• Axial psoriatic arthritis develops at an older age, is less symptomatic, and is associated with distinct radiographic features compared with ankylosing spondylitis.

• The majority of comparative studies to date have had a cross-sectional design, which captures patients at different stages of disease and hampers the true comparison of these two diseases.

• The lack of a universally accepted definition of axial psoriatic arthritis needs to be addressed.

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This article is part of the Topical Collection on Spondyloarthritis

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Gladman, D.D. Axial Psoriatic Arthritis. Curr Rheumatol Rep 23, 35 (2021).

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