Division of Rheumatology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, United States.
Case Western Reserve University School of Medicine, Cleveland, OH, United States.
Joint Bone Spine. 2024 Jan;91(1):105625. doi: 10.1016/j.jbspin.2023.105625. Epub 2023 Jul 24.
Axial psoriatic arthritis (axPsA) has considerable overlap with axial spondyloarthritis (axSpA) but has some unique features that sometimes preclude classification into axSpA. It has some clinical and radiographic differences compared to axSpA. Imaging typically shows asymmetric syndesmophytes, mainly in the cervical spine, with less frequent sacroiliitis. It more commonly presents later in life and is associated with less severe inflammatory back pain than axSpA. The interleukin (IL) IL-23/IL-17 axis is central to the pathogenesis of both diseases. However, the response to therapies targeting these cytokines has been different. IL-23 inhibitors are ineffective in axSpA but may be effective in psoriatic arthritis (PsA). Recent post hoc analyses of clinical trial data with IL-23 inhibitors in PsA have raised the possibility of their efficacy in axPsA and need evaluation in future clinical trials. Moreover, there is a need for classification criteria for axPsA and better tools to assess therapeutic response.
轴向银屑病关节炎（axPsA）与中轴型脊柱关节炎（axSpA）有很大的重叠，但也有一些独特的特征，有时会导致其无法归入 axSpA 分类。与 axSpA 相比，它具有一些临床和影像学差异。影像学通常表现为不对称性的韧带骨赘，主要发生在颈椎，且骶髂关节炎的发生频率较低。它通常在生命后期出现，且与 axSpA 相比，其炎症性背痛程度较轻。白细胞介素（IL）IL-23/IL-17 轴是这两种疾病发病机制的核心。然而，针对这些细胞因子的治疗反应却不同。IL-23 抑制剂在 axSpA 中无效，但在银屑病关节炎（PsA）中可能有效。最近对 IL-23 抑制剂治疗 PsA 的临床试验数据进行的事后分析提出了其在 axPsA 中有效性的可能性，需要在未来的临床试验中进行评估。此外，还需要 axPsA 的分类标准和更好的评估治疗反应的工具。
