Sacroiliac joint involvement in psoriatic arthritis - MRI, radiographic and clinical findings in 581 European routine care patients.
Publisher DOI
PubMed ID
41023760
Abstract
Background
Axial involvement in psoriatic arthritis (axPsA) is associated with more severe disease and increased pain, yet no consensus definition of axPsA exists. This study aims to describe the occurrence and characteristics of MRI and radiographic sacroiliac joint (SIJ) involvement in a European PsA cohort.Methods
Patients with a clinical diagnosis of PsA or of axial spondyloarthritis with psoriasis and available routine care SIJ MRIs were included from five European registries in the EuroSpA collaboration. SIJ MRIs and radiographs were centrally assessed for inflammatory and structural lesions, differential diagnoses, and globally evaluated for SpA-indicative findings.Results
Among 581 PsA patients (mean age 45 years, 47% male), 31% exhibited SpA-indicative SIJ-MRI findings (MRI-axPsA). In MRI-axPsA patients, the most common lesions were bone marrow edema (BME) (69%), erosions (68%), and fat lesions (58%), generally present bilaterally. BME ≥ 1 cm, inflammation in an erosion cavity, capsulitis, fat lesions ≥ 1 cm, backfill, and ankylosis were observed almost exclusively in MRI-AxPsA patients. Differential diagnoses included osteitis condensans ilii (8%), probable strain-related BME (11%) and degenerative disease (16%). Among 259 patients with radiographs, 29% met the radiographic mNY criteria for ankylosing spondylitis and 38% had SpA-indicative MRI findings. Male sex, HLA-B27 positivity, elevated CRP and history of inflammatory back pain (but not current back pain) were independently associated with MRI-detected axial involvement.Conclusion
In this large European cohort, one-third of routine care PsA patients had axial involvement, based on global SIJ MRI assessment. The study supports incorporating MRI into the future definition of axPsA to enable early identification.
Axial involvement in psoriatic arthritis (axPsA) is associated with more severe disease and increased pain, yet no consensus definition of axPsA exists. This study aims to describe the occurrence and characteristics of MRI and radiographic sacroiliac joint (SIJ) involvement in a European PsA cohort.Methods
Patients with a clinical diagnosis of PsA or of axial spondyloarthritis with psoriasis and available routine care SIJ MRIs were included from five European registries in the EuroSpA collaboration. SIJ MRIs and radiographs were centrally assessed for inflammatory and structural lesions, differential diagnoses, and globally evaluated for SpA-indicative findings.Results
Among 581 PsA patients (mean age 45 years, 47% male), 31% exhibited SpA-indicative SIJ-MRI findings (MRI-axPsA). In MRI-axPsA patients, the most common lesions were bone marrow edema (BME) (69%), erosions (68%), and fat lesions (58%), generally present bilaterally. BME ≥ 1 cm, inflammation in an erosion cavity, capsulitis, fat lesions ≥ 1 cm, backfill, and ankylosis were observed almost exclusively in MRI-AxPsA patients. Differential diagnoses included osteitis condensans ilii (8%), probable strain-related BME (11%) and degenerative disease (16%). Among 259 patients with radiographs, 29% met the radiographic mNY criteria for ankylosing spondylitis and 38% had SpA-indicative MRI findings. Male sex, HLA-B27 positivity, elevated CRP and history of inflammatory back pain (but not current back pain) were independently associated with MRI-detected axial involvement.Conclusion
In this large European cohort, one-third of routine care PsA patients had axial involvement, based on global SIJ MRI assessment. The study supports incorporating MRI into the future definition of axPsA to enable early identification.
Date Issued
2025-09-29
Publication Type
Article
Subject(s)
Subjects
Axial psoriatic arthritis
•
Axial spondyloarthritis
•
Imaging
•
Magnetic resonance imaging
Language(s)
en
Author(s)
Vladimirova, Nora | |
Hadsbjerg, Anna Ef | |
Krabbe, Simon | |
Ciurea, Adrian | |
Bubová, Kristýna | |
Gregová, Monika | |
Nissen, Michael J | |
Micheroli, Raphael | |
Pedersen, Susanne J | |
Závada, Jakub | |
Snoj, Ziga | |
Pintaric, Karlo | |
Gudbjornsson, Bjorn | |
Rotar, Ziga | |
Eshed, Iris | |
Sudol-Szopinska, Iwona | |
Gosvig, Kasper | |
Diekhoff, Torsten | |
Lambert, Robert Gw | |
de Hooge, Manouk | |
Donzallaz, Maurice | |
Bernatschek, Alexander | |
Hetland, Merete Lund | |
Ørnbjerg, Lykke M | |
Østergaard, Mikkel |
Additional Credits
Journal
Arthritis Research and Therapy
Publisher
BioMed Central
ISSN
1478-6362
1478-6354
Access(Rights)
open.access